Monday, April 29, 2013

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It seemed like we were getting somewhere. You were sitting there, atrophied legs crossed and foot twitching nervously. Your bony clavicles were jutting from beneath your skin like some kind of carefully crafted relief sculpture. Even though you were young and sick--and mostly difficult and defiant--there was something delicate about you. I felt myself wanting to protect you.

I was patient. You let me peel back each layer of that outward onion skin until both of us sat there with eyes glistening. This was a lot, you told me. More than a notion, you'd said. And I agreed because that part was true. It was more than a notion and it is a lot. But still, I told you, if anyone could handle it, you could. That's what I said and when I did your cheekbones rose high on your face, exaggerated by your nonexistent body fat composition.

There is a stigma attached to HIV and AIDS. You didn't say that and neither did I, but we both knew that it was the elephant in the room. A bully of an elephant, too. Pinning your chest to the ground and leaving your cachectic limbs flailing underneath. For a few moments I tried to clarify the differences between being HIV positive versus an AIDS designation but the more I talked the more the words felt empty and pointless. Like they fanned the flames of these warped ideas that kept people hiding and afraid. Another line drawn between the awful and the awfuller. Another reason to be judged depending upon where you fell. From the look on your face, I knew that none of that resonated with you anyway. To you, it is all as one and the same. Bad. And shameful. And the consequence of a life in the shadows.

Because that's what the stigma tells you.

See, that's when I identified that it wasn't just them.  You, too, were giving life to that stigma. Seeing it in your own reflection as a reminder of poor choices, or even worse, just unworthiness of something better or more full. You, a same-gender loving man represented those spotted, nameless, hopeless images of the early AIDS epidemic. The ones who had it coming. See, this version was your lot in life. This. Not that robust, laughing, living Magic Johnson version.

You brought him up first, not me. I never bring up Magic. But you did and when you did, you said to me with a somber shrug, "He's rich." And I peeled back another layer of onion skin and replied to you, "So are you."

You froze on those words. Watching my mouth to see if I was serious and I let you because I was.

"What are you afraid of?" I finally asked.

You blinked in slow motion; I noticed your long, fine eyelashes for the first time. With your head toward the window you gazed off somewhere distant. The room fell silent. And I let it.

"What am I afraid of?" you repeated.


"I'm afraid of the dark. That's what I'm afraid of."

I watched you to see what you meant by this, but your face was still pointed toward the Atlanta skyline. When you turned back toward me, I understood.

"You know what? I think we're all kind of afraid of the dark, sometimes. At least I am."

"Do you think Magic Johnson is?"

"Magic Johnson?"

"Yeah. Do you think he's afraid of the dark?"

"I think we all have a dark that we fear, don't you?"

You didn't answer that. Instead you skipped to another question which was fine with me. "You know what I wish?"

"What's that?" I asked.

"I wish I could have been like Magic when I found out. With money and a wife instead of alone and in love with a man who didn't even care enough to check on me. And a family that don't like my lifestyle."

I paused and let that sink in before speaking. "You know what? I bet you Magic wishes some things, too."

"You think?"

"I think everybody wishes something. Everybody."

I know this because I spent the rest of the day wishing I had some other kind of magic that might stop you from being so afraid of this darkness that you live in.


Welcome to Monday.

Sunday, April 28, 2013

Systolic murmurs.

Good morning, my friends. I am sitting at my kitchen table--half awake/half asleep--drinking a much needed cup of coffee. Rest, however, would be better than the coffee but isn't an option at the moment.

I'm tired. My muscles are moving and going and doing. Big hurdles to jump and achievements to achieve. And all of it has been good but . . . tiring. Kind of like exercise, you know? It feels good, but especially after you've finished it.

I just returned from the Society of General Internal Medicine conference in Denver, Colorado. I'd never been to Denver (in my adulthood) and it was amazing. Saw one of my best friends, Falona, who happens to also be my line/pledge sister and fellow Meharry alum. I've known her since we were nine years old and being there on her turf was awesome. The meeting was great, too.

Lots in my head to share. Looking forward to getting it out of me and into our community of thinkers. I love our community of thinkers. I do. I love every single bit of it because I think we make each other better. At least you make me that way.

Sigh. I have to go round at Grady right now. Yes. On a Sunday after getting in from out of town. But it's cool because I signed up for this. And I'm super thankful that my mentorific mentor slash fellow Grady doctor, Neil W., was gracious enough to care for my inpatient service in my absence. It's nice to be down with smart people. At least, that's what I think.

Man. Travel, patient care, teaching, deadlines. . . sure. . . it feels good to be productive.  And, I guess, since I love what I do, it's all a "heart" thing. But. With so much going on, just like any heart muscle contracting, it's work--or systole as we call it when heart muscle does its job.

Me? I'm ready for my heart muscle to relax for a bit. Time for some diastole. . . . .refilling and repolarization, man.


Happy . . .yawn. . .Sunday. Here's an old post about systole and diastole in work/life balance.

Thursday, April 25, 2013

Fight or flight.

My head was down and I was looking at my list of patients. Trying to figure something out about someone and doing so while pushing my way through the revolving doors at the front of the hospital. The work day had come to a close. The patients had been seen and we'd all spent time teaching each other. And so, like I always do, I did my ritualistic mental sign-out rounds with my marked up patient print-out preparing myself for what I'd need to read that night and do the next day.

My shuffling feet stayed in step with the automatic doors and inside of the tiny slice of space I was given to exit. The sun was unusually bright when I finally made it out. I looked up and squinted for a second and then I returned to what I was doing. Walking, thinking, reviewing, revising. And then, this:

"'Scuse me, miss. 'Scuse me."

My eyes immediately met those of an anxious appearing man. His hair was matted and his lips were cracking. His movements were jerky and seemingly unpredictable. And then, as he spoke again, he stepped closer. Into my personal space.

"Umm. . .I don't mean to bother you, miss. But. . .um. . .can you tell me how to get over to the Marta?"

His proximity was scaring me. My instincts told me to pay attention. To him. To everything. I stepped back a bit and replied, "It's straight ahead of you."  I was careful not to turn my head away from him when I said that. Something about the way his eyes were flitting about and his body kept moving so restlessly made my pulse quicken.

My purse was resting on my shoulder. I was wearing a shoe with a moderately high heel.  I began thinking about all of the things that would have to be taken into account should I need to get away. Or fight. My fingers tightened around my strap as I positioned myself to leave. Or something.

"Ma'am, I was wondering if--" He reached his hand out toward my shoulder as he said those words. And now he was very close to me. Very. I scanned the area and was stunned at how, at this particular moment, there seemed to be not one other person nearby. That hand reaching for me startled me. Wait. It more than startled me--it ignited something inside of me that's hard to explain.

I stopped his hand--almost swatted it away--before he could reach my body and spoke loudly. "I have to go. I can't help, I'm sorry."

I moved back and started to walk away from him as quickly as I could. And not in the direction that I was initially going, but instead in the direction of the Emergency Department where I knew I would find more people. That brisk walk became a jog. And I did that until I reached the corner by the ED.

When I looked back, I saw that man still in the same area near the door. Nervous, jerky, anxious-appearing. For a moment, I felt bad for leaving like I did. But then I heard Harry in my ear saying, "You work downtown in a major metropolitan city. Pay attention and if you feel like something ain't right, get the hell out of there." And that is exactly how he said it and how he says it to me when talking to me about my Pollyanna-ness about the world and the people inside of it. Sometimes he uses an f-bomb during that admonishment for emphasis. Just so I'll pay attention.


A security officer near the emergency entrance had seen me trotting and asked if I was okay. I told him yes, but did at least mention that I felt a little weird when that gentleman had approached me.

"Oh, that dude's just trying to get high. Let me go down there and get him to keep it moving." And that's exactly what he did. He came down there with a bellowing voice and brushed that man away like debris on a sidewalk. I stood on the corner watching the whole thing. . . .not really knowing how to feel about it. Bad? Wrong? Smart? Right? Sigh. I don't know.


I work at Grady Hospital in the heart of downtown Atlanta, Georgia and it is a place that is near and dear to the most tender parts of my heart. But. This hospital I love sits in the epicenter of some harsh realities that I must remember to acknowledge. I'm thankful for a streetwise husband who regularly makes sure that I do. And you know? I don't know what that man wanted from me. Maybe all he wanted was a dollar to ride the Marta train and that's it. Or maybe he just wanted a dollar to get a hamburger or a few loose cigarettes. Maybe. But maybe he was sick and desperate from an addiction and wanted to get his "medicine" by any means necessary. Maybe he, too, saw that there wasn't anyone out there and that this lady doctor who was looking down and not up might be a good target to help him with getting that "medicine." Maybe.

I don't know. But I do know that we have the "fight or flight" instinct for a reason. That part I know for sure.


Happy Thursday.

Now playing on my mental iPod. . . 

Monday, April 22, 2013

Good sports.

Here is my Isaiah at his golf lesson last weekend. He is so analytical and methodical. I love how he thinks about everything from the position of his arms to following through after the swing.

You can even see it in his coach's face. He looks good out there. Kind of like Tiger Woods. (But without the money or the bad press.)

Hee hee.

BT-dubs (as my middle school niece says) -- We aren't anti-Tiger over here. So don't start busting on Tiger Woods in the comments, man. Just because the brother has no game when it comes to his romantic life doesn't mean we can't respect his game on the green. (I also never stopped loving Bill Clinton, either.)

Just sayin'.

Here is my Zachary showing off his very first medal in track and field. Woot woot! Although he runs the 200, 400 and 4x400 relay, this baby was earned in the long jump. Yes. The long jump.

Now. If you are imagining what "the long jump" looks like between six and seven year olds, know that it is probably just as you imagine it. Tiny legs going about two inches into sand.

This time, though, his tiny legs went the furthest.

And his quote about that was, "You know what, Mama? I like winning. Even when they keep saying 'just have fun,' I always think I like to have fun and win."

Well. There you go.

What kind of sports or activities are the little ones in your lives up to?

Happy Monday.

Friday, April 19, 2013

This made me smile today.

Deanna left out the part where I said "kind of like that movie The Notebook but without the dementia." That always cracked her up so it was one of our favorite jokes together. So funny that she repeated it on Facebook! This also just made me LOL about the day that, on Deanna's insistence, I ordered The Notebook on pay-per-view and had to shut it off not once but twice because I was crying so hard. I called Deanna and screamed at her for not warning me and she just laughed and laughed. (Kind of like when I screamed at her after she suggested I read Fifty Shades of Grey.)

Man. Such a great memory that I'd forgotten until just now. Love that my friend Stacey sent this to me today as a reminder. It totally made me smile from ear to ear.

And you know what? Now I bet you're smiling, too.

Happy Friday again.

The other day.

"We'll need to discharge Ms. Pleasant early, I hope you don't mind. I know it's awful but it turns out that her son unexpectedly has passed away yesterday. She just found out and the family needs to get her home. Are you okay with going to see her before we round so that we can help expedite things for them?"

This is the first thing my resident said to me a couple of mornings ago. I take that back. First, she said "good morning" and then she said this. Her face was solemn and her eyes were filled with the quiet respect you offer at times of loss.

"Her child? He died?" I needed clarification. This woman wasn't far from my own mother's age so her "child" had to be an adult. But still. She wasn't old enough to be in that range of having kids who've crossed over into the "elder" designation. I knew that this son couldn't have been much older than me.

Or Deanna.

"Yes, ma'am," she confirmed.

Here's the thing. That day was only my second day on the service. This wasn't someone with whom I'd built a strong rapport or had gotten to know already. Her family hadn't shaken my hand or pulled me aside in hallways for questions. So this? This would be hard on multiple levels.

Multiple levels.

"Okay." That's pretty much all I said. Then I looked over at Jessica, the senior medical student on my team, and asked her if she would come with me. And perhaps when she obliged, she thought I was inviting her because it would be some kind of teachable moment. Maybe it would be, but really, I just wanted her there for support.

For me.

Surprisingly, I've been okay with watching people grieve since the passing of my sister. Though I believe my level of empathy and understanding have dramatically increased, my outward emotional reactions have become more contained. My touches and encounters with those who are hanging onto those tiny threads after gut-wrenching good-byes are approached with a new understanding. This is a walk that they will have to make. The new normal, unfortunately, must begin somewhere. So I do my best to be as intentional as possible about simply being present in their moment with them. Because I know that after that, regardless of how much love surrounds them, grieving is a very personal thing.


But this? This would be different. This wasn't a family who'd just lost a parent. This wasn't a long term couple with a half of a century of marriage behind them nearing the end of a long battle with some illness. This was a mother. A mother who'd just found out that her child--her child with life yet unlived--was now gone.

And so, with Jessica by my side, I approached the room. I could already feel my pulse quickening and some kind of strange emotion mounting inside of me. Before I could even get into the room, I encountered two women who identified themselves as her daughters. Which meant they were his siblings.

"My name is Dr. Manning. I'm the senior doctor on this team caring for your mother and I just learned of your loss. I know we haven't met, but I am deeply sorry."

And they both smiled and shook my hands and seemed appreciative.

Normally, I knock on a nearby wall and turn on the light switch as I enter. But not this time. The room was mostly dim. That seemed appropriate. It was overcast outside. My patient was sitting in a chair facing the window and those gray clouds. Something about that seemed to fit, too.

Carefully I approached while quietly acknowledging the other family members present. Once I reached her on the side of the bed, she slowly turned her head away from the window and looked at me. I knelt down before her and took one of her hands.

"Ms. Pleasant? I am so, so sorry to hear of your loss."

She nodded and tried her best to smile with those lost eyes. But she kept them on me. She did. Almost like she knew that I knew something. Or like she knew that I'd looked into eyes like hers before.

"There aren't any words I can say," I spoke softly, "There just aren't. But please know that I promise to pray for you by name, Ms. Pleasant. I will pray for your peace and for everyone who loves you and your son. I promise I will."

And I said that because it was true. I wanted her to know that I would do the thing that I thought I could do. And sure, not every person is a pray-er, but I am. So this is what I wanted her to know.

She seemed to appreciate that.

Then she deepened her gaze at me, eyes now brimming with tears, and something punched me hard in the center of the chest.  Hard, hard, hard in the chest. I'd seen these eyes before.


I squeezed her hand and stood to my feet. Taking a deep breath, I addressed the rest of the family. "Your loss deeply matters to us. It does. Your mother's health right now is okay for her to go home and we are taking care of getting the discharge paperwork, okay?" They murmured soft words of obligatory acknowledgment.

I needed to remove myself. The last thing I wanted to do is start crying in front of this grieving family.  No way, no how. So I gave condolences again and prepared to leave. Just as I did, I felt my feet sticking to the floor. There was more to say.

I looked over at Jessica, standing near the wall. Her hands were clasped in front of her in deference. I liked the way she respected this moment and I appreciated her being there. I did.

"Um, I just. . . wanted you to know. . . . I . . listen. . .my family experienced unexpected loss a few months ago. Um. . .my sister. . .yeah. . .well, she died last November." Something about that grabbed the attention of every person in the room including Jessica against that wall. It even moved Ms. Pleasant's eyes away from that dreary window scene. I immediately wondered whether or not I should have said this, but now it was too late. "She was less than two years older than me. And. .  . yeah. . . .I guess the reason I'm even telling you is because I just want you to know that I really am sorry. Sorry because there haven't been words that I have had to make my own mother feel better and also sorry because . . .  I'm just sorry you have to live through this."

That whole family was weeping when I said those words. And I swear to you, I was coaching myself with all of my might not to do the same. Something about telling them about Deanna seemed to fuse us all together. And, perhaps, this confluent grief made us one.

"I meant it when I said I would pray for you by name. And I will pray for each of you to know how to support your mother and each other. I promise that I will."

This time, I could tell that they believed me. And they should have because it was true.

I left that room and went into our team room where my resident, interns and other students were waiting. None of them knew before then that I'd lost my older sister just five months before. But since I could no longer contain my mounting emotion, I had to let them know right then and there.

I sure did.

And so I wept. Hard. And I told them all of this extraordinary human being I grew up with and how seeing Ms. Pleasant with those eyes reminded me of November 16, 2012 when I put my arms around my own mother and then made her go get back in bed. They were gracious and patient with me.  They were.

And it was only my second day on the service.

Here is what I know. I know that this will happen sometimes. I know that people are kind--they are--and that it's okay to cry on some days even in front of those same kind people and to be patient with myself when I do. I know that my friend Nancy who lost her beautiful daughter Nicole told me that for the rest of my life Deanna's spirit will walk into rooms and sometimes catch me off guard when I least expect it. And that some parts of that experience will rise up mighty and collapse me sometimes and to just be tender to myself when they do. I know for sure that she was right about that. All of that.

Yeah.  So the other day, my grief overlapped that of another. And I'm thinking that sometimes it helps everyone just a little bit when that happens. That's what happened to me on wards the other day. And my guess is that it won't be the last time it does.

No, it will not.

Happy Friday.

Tuesday, April 16, 2013

My man.

Isaiah and I went to have the coat of pollen washed from my car yesterday. When they called for my car to be retrieved, I put some cash in Isaiah's hand and closed his fingers around it. "Here. Give this money to the man who gives Mommy her keys back."

Over we walk and this big, muscular gentleman smiles and says, "How are you, ma'am? Do things look okay?"

And I chuckle back and reply, "Anything involving water on this car is an upgrade. Trust me."

And this pleasant man nodded, put my keys in my hand and pulled open the door for me.

"Excuse me, sir."

That big man swung around when he heard a little person's voice. Isaiah extended his hand and handed the cash to him. His young eyes were flitting from side to side, perhaps a bit afraid of this Paul Bunyan-like fellow and his soiled t-shirt. Then he glanced at me and then stared exaggeratedly into that man's eyes. "This is your tip. Thank you."

And that man seemed to appreciate the whole thing. "I like that. He looks a man in the eye."

"And a woman, too," I teased. "His daddy drills that into his brother and him."

Isaiah looked a bit embarrassed. But he shouldn't have been.

Early this morning, I stood over a laundry basket. It was out in the hallway instead of empty next to the washer and dryer and, okay, I'll admit that this is where it had been for two days straight. Hunched over it, I sifted through little shirts and shorts and ninja underwear in search of matching pairs of socks for school. It wasn't going fast enough, so I plopped down and sat cross-legged on the floor.


Then, from where I was sitting, I could see straight through my bedroom door to the edge of our bathroom. A simple morning ritual was taking place. Two boys standing side by side. One with a face perched upward while one firm, adult hand holds it steady by the chin as the other sure, paternal hand carefully cleans every trace of sleep from it with a warm wash cloth. I studied the muscles in his forearms, flexing as he explored crusty nostrils and dusty ears. The other brother waits silently; he knows the drill. In preparation for his turn in the assembly line, he clumsily brushes his hair in forward strokes.

"Like this, Dad?"

"Forward on top. Backward on the back. Just like that."

"Okay, Dad."

"My man."

Still, like always, those strong hands come behind those little ones. Rebrushing. Regrooming.

"Fix your pocket, son."

"Yes, Dad."

"There you go." Then an uber-manly hand slap. The tenth one that morning. "My man." 

I get so lost in watching, it startles me when I hear my name.

"Mommy, do we have socks ready?"

I shake my head and come to. I dig vigorously some more and finally come up with two pairs. "Here you go."

Socks and shoes. Cereal, coats, backpacks. And in between there are discussions going on between father and sons which are mundane but perfect. Peppered with these things I hear every single day in my home like:

"Son, put your eyes on me when you talk. Look people in the eye, son. You understand me?"


"Who is 'yeah?' We don't answer Mommy or anyone with 'yeah.' You got that?"


"My man." 

Today I saw and heard all of this, these things that are part of the daily fabric of our morning life. And as ordinary as it was, something about it felt extraordinary. All I could think was, "This father who is loving on these children and showing them how to be men is my husband. And he loves me as much as I love him."  Then, being the mushball that I am, I bite the inside of my cheek to keep from crying at that thought because I know this isn't promised and that planets don't always align like this. Not like this, where a good man falls in love with you, marries you, has children with you and then loves all of you with sustained intensity without giving up.

It happens, but not always. It doesn't.

Shoe shine with Daddy

Note: Harry had on sneakers that day and is only wearing shoes for the shine. . Now, you already know the BHE wouldn't be caught in gym socks and dress shoes!

So yeah. Right now, my little boy's eyes might jump nervously when speaking to a new person, but eventually they won't. And he will go somewhere caring about how he is groomed and he'll be speaking up so that his voice can be heard.

And me, I'll be somewhere watching just like this morning and knowing the love that went into getting those boys there. And still feeling unbelievably fortunate to have attracted this extraordinary human being as my life's partner.

My man.


When you say, "My man," it's this version. This is how the BHE says it--Denzel style.

Sunday, April 14, 2013

Sixteen Questions: The Emotions of Career Decisions in Medicine.

There were these days where I just disappeared into the shadows. I could be there, I could be gone, I could be standing there for the entire time those rounds lasted with my middle finger pointed straight in the direction of the attending or the senior resident and I feel certain -- quite certain -- that no one would have noticed.

Not a one.

"Are you the student joining our team?" my attending asked. His eyes looked nice. Well. As nice as eyes can look when covered with an entanglement of unruly salt and pepper eyebrows. When he said that, they furrowed down first and then raised up. Like two very surprised giant bi-colored caterpillars. Ick.

"Sir?" I answered. That was all I could really say because, actually, that was his second time saying that to me in the two weeks since I'd been there. Complete with eyebrow acrobatics both times.

"Don't worry! I'm one of the nice ones," my attending said to me with a chuckle. "You don't have to worry about me grilling you or anything." And he said that part after shaking my hand and introducing himself to me for the second time in two weeks.

If "grilling me" would mean paying attention to me then I'd take it. I would.

"I think she was here with us last week." This was what the resident said to counter that Groundhog Day-like introduction from my attending. Because, I swear, he said the exact same thing to me the first time. That resident didn't even look in my direction when he said it either. Perhaps he took it as some opportunity to one-up his attending which, I had noticed from my position in the shadows, was something he seemed to relish in doing.

You "think" I was here with you last week? You "think?" Wow.

The interns at this rotation site did sort of talk to me. I'll give them that. The intern on my team was more than happy to send me out on scut-tacular field trips to spin down urine and gram stain slobber. Particularly if said job needed to be done at midnight or later. There was another intern that was very pleasant to us students, but she always seemed so scared that she made me nervous. Then, of course, there were  these other two intern guys who were extremely friendly to my friends and me. Extremely. They taught us things and showed us EKGs and asked us if we wanted to have lunch with them and things like that. And yes, now that I am much older, I recognize that they were being part-medical student centric and part-fresh, and probably even recognized that then, but never really thought much about it. Because at least I wasn't invisible then.

I cannot recall a single teaching point made by that caterpillar-brow attending. I can only remember that he always showed up in a blazer and tie and not a white coat and that he seemed to take great care in picking out his perfectly round, albeit small, afro. Whenever we had attending rounds which, back then before duty hours reform and billing rules changed, was only a few times per week, I would just stand there daydreaming and waiting for it to end.

And that was how it was on my very first rotation as a third year medical student. The good news is that just a couple of weeks later, my next attending seemed far more engaged than that one. And who knows? Maybe the guy had some personal issues going on or was simply burnt out. I don't know. What I do know is that it wasn't one of my more cherished experiences in medical school, that's for sure. (Fortunately, most of my other experiences in medical school were worth cherishing, so note that this is not a dig at my beloved alma mater by any stretch.)

Yeah. I guess it's just so hard to believe that I actually chose to go into the very field connected to such an unpalatable experience. But I did.

Internal Medicine. Imagine that.

Initially, I was pretty certain that I'd go into surgery. In fact, I was rather enamored by transplant surgery and had it set in my head that I would do a general surgery residency followed by a fellowship in transplantation surgery. And then, as I often told people in one altruistic breath, I would get African-Americans to sign up to be organ donors and transplant kidneys into my people.


You have to admit that it was a rather noble aspiration. At least I think it was. And honestly, my very next rotation -- surgery -- was the polar opposite of that Medicine rotation. Every attending knew exactly who and where we were as students at all times. They called us by name and had expectations of us. Which, now that I recall my experience on that first month of the Internal Medicine clerkship, I recognize as the problem. No one had any expectations of me. So I rose -- or rather sunk -- to that expectation. Nothing.

It only made sense that my academic advisor was a female surgeon. She was kind and attentive and smart. On most days, I wanted to be her. At least, the professional version of her. And I owe it to her for noticing how much I came alive when caring for our post-operative surgical patients on the wards. She pointed out to me that surgeons get excited by the OR. In fact, they can't live without it.

And that statement led to an epiphany for me. One that made it clear that my future career would not involve twirling into sterile gowns in operating rooms.

I chose a combined residency in Internal Medicine and Pediatrics. And never looked back.

I'm reflecting on this on this early morning because many of our students are choosing specialties right now. They're trying to make sense of all of it and working hard to separate the emotions connected to the specific experiences from the actual field itself. And that's hard.

The emotions I had on my Internal Medicine rotation were mostly negative. Not mattering enough to be remembered stung. And that overpowers nearly all of my memories of that time. So very early on, I was certain that no matter what I did, it wouldn't be that. Pediatrics was a mostly okay experience and my feelings working with the Pediatricians were positive. Still, I didn't necessarily feel my heart leaping at the thought of doing it exclusively for the rest of my life. Of all of those clinical experiences in third year, Surgery was, hands down, the one that I always look back upon with warm nostalgia.


See, that's dangerous, too. It's dangerous because it can lead a student down a path that isn't theirs to follow. I know this for sure because now, thanks to that caterpillar-attending-dude, I bend over backwards to make certain that no learner on my team EVER feels ignored. EVER. And I recognize that noticing people makes them feel good and brings out the best in them. Which can lead to very positive emotions.

When I meet with students about their career choices, I tell them, "I want you to choose the field that is best for you. So know that it's okay if you change your mind because I did." And I say that part particularly to the ones who come to me with their sights set on Internal Medicine. Which, yes, is super awesome.

To me.

My rockstar-female-surgeon advisor gave me some good advice that changed the trajectory of my career. And I'm so glad she did. In the spirit of that advice, I have come up with a list of my own that I think could greatly help students who are muddling through the emotions-versus-specialty conundrum with career choices. (Perhaps a lot of this can even be applied to selecting a major in college, although we have several engineers and art history majors in our medical school.)

I bring you:

Dr. Manning's SWEET SIXTEEN questions  
for all medical students to consider 
when choosing (or not choosing) a specialty:

  1. How do you feel about communicating with people? Do you enjoy explaining and discussing things? Do you mind challenging interactions? In other words, how do you feel about a career that involves a lot of talking?
  2. When you went into the OR as a student, did you finally feel at home? Could you be okay with NOT being in an operating room? Does the thought of NOT being in an operating room make you break out in a cold sweat? Do you feel yourself longing to talk to the patient instead of cauterize their blood vessels? Are you okay with taking care of people who can't talk to you at all?
  3. Do you have many, many different interests or a few interests that you spend significant time enjoying? In other words, is it more fun for you to hyperfocus on one area or broadly focus on many?
  4. How do you feel about children? Particularly ones that aren't related to you? Do you see them in grocery stores with their parents and want to hold them? Are you the person who asks questions like, "How old is she?" or  "How long has he been walking?" not because they have stepped on your foot in line but because you genuinely want to know? Or do you run the other way and (though you hate to admit it) wish there was a "no kid" rule along with the no smoking rule at certain restaurants?
  5. How do you feel about procedures? Do you like them? Does blood freak you out? Can you do with out anything that interrupts the skin's integrity or requires a consent form?
  6. Are you willing to be on call? Specifically, would you be against someone calling you on a cell phone or pager in the middle of the night because your expertise is urgently needed?
  7. Do you prefer longitudinal relationships with patients or are you okay with short glimpses into the lives of many people? For example, were you constantly wondering what happened to every single person you saw on Emergency Medicine and did you often find yourself reviewing the electronic medical record long after the encounter?
  8. Do you like things that get your adrenaline pumping? Does the thought of jumping from a plane or bungee-diving from a bridge make you want to vomit? Or does that make you squeal with glee? Now--translate that to a specialty. How do you feel about high stakes, high paced medical care? Does it excite you or overwhelm you?
  9. How confident are you? Some specialties require a lot of it. Just saying.
  10. How do you feel about bodily fluids? Not just blood, but all of them? Totally, completely grossed out? Or "meh"? 
  11. How do you feel about working with the nether regions? Oh--not clear enough? Does it completely mortify you to examine a tender testicle or to explore an agonizing anus? There is a lot of reward in making people feel better when they have problems below the waist line--but it ain't for everyone.
  12. Do you love medicine? Not Internal Medicine, per say, just . . . medicine? Do you feel like it is what you were meant to do? Like, if you won the lottery and you were fully trained, would you go in to see patients the next day? Or would you give the office and hospital the same middle finger that I considered giving the caterpillar-attending way back when?
  13. After answering number 12, ask yourself this: How hard are you willing to work? Is it your expectation to be gone every single day by 2PM? Are you (though you hate to admit it) kind of lazy? Or is your mantra "go hard or go home?" 
  14. Are you okay with fields that involve high incidences of death? Are you okay with managing problems for which there is no known cure to date? 
  15. How do you feel about research? How do you feel about teaching? For each of those things on a scale of one to ten for "OMG-yes-I-love-it"-ness, what would you give them?Also, how do you feel about practicing in rural or international settings? Apply that scale to that as well for both of those settings.
  16. How do you feel about taking care of poor people? How do you feel about taking care of rich people? How do feel about taking care of very, very poor people? How do you feel about taking care of very, very rich people? (These are things you ask yourself and answer to yourself only.)

Oh, and you probably noticed the absence of the money-slash-earning potential questions on this list. My feeling is that, in general, all physicians make "good money." Now. How you define "good money" is personal. It's up to you to decide whether or not that will be factored into what you do. It wasn't a consideration for me, but I acknowledge that that's just me. I don't judge anyone who feels differently because at the end of the day, all anyone can be is happy.

Ya dig?

Now. After exploring these sixteen questions (which YES, I KNOW were far more than sixteen)-- you will find that voila! Some work environments and specialties will be narrowed down, nixed or frontrunners for you as a result. Next, schedule a meeting with a trusted advisor to help you explore this some more. The key is to tease the emotion away from the "real" parts. And yes, the emotions could be because of things on that list of questions, but you just want to be sure that -- good, bad or indifferent -- it isn't because of. . . . . well. . . people or a person. Especially the "indifferent" part. Does that make sense? I hope so.


You know what? I just realized something. That caterpillar-eyebrow attending did teach me something. He taught me what not to do with medical students. And now that I think of it, he changed the trajectory of my career, too.

That's all I've got this morning. Pass this on to a medical student. 'Cause you know I love the kids.

Happy Sunday.

Now playing on my mental iPod. . . ."Emotions" by Mariah Carey. And yeah, she was speaking of a different kind of emotion, but you get the picture.

Thursday, April 11, 2013

Top Ten: Spring Break Happiness

Here's a tiny part of my brief happiness inventory over our last few days away from it all. Thought I'd share a quick little top ten in pictures and captions. Like to hear it? Here it go.

Let's keep this simple shall we?

#10  Happiness is. . . . .

. . . kids who appreciate the end of the long car drive allllll the way from landlocked Atlanta to the land-unlocked ocean. And who react perfectly when they first see the surf because seeing the surf is something to jump about.

#9   Happiness is. . . . .

. . . . turning a cousin into a mermaid.

#8  Happiness is. . . . .

. . . . witnessing six year-old yoga poses on the beach. 


#7   Happiness is. . . . . 

. . . . flexing like no one's watching.

#6  Happiness is. . . . . .

. . . . catching sand crabs and baby molluscs. . . .

. . . . and then letting them go.

#5  Happiness is. . . . . .

. . . . big cousins who don't mind having little cousins around. . . . .

. . . because little cousins like to be around big cousins.

#4  Happiness is. . . . . .

. . . . getting a new pair of extremely cool shades (and your mom not making a big deal when you choose to wear them at night.)

#3   Happiness is. . . . . 

. . . . waking up to this view every morning.

#2  Happiness is. . . . . .

 . . . .unexpectedly discovering that your very best second grade friend on the entire planet just happens to have overlapping vacation locations with you and your family. . . . . . .

. . . . . and your parents actually having their acts together enough to arrange a playdate for you that lasts almost until sunset.

#1   Happiness is. . . . . . 

. . . . realizing that your children respect the power of love and friendship. . . . .

. . . . . and moments like these.

Happy Spring Break.

Now playing on my mental iPod. . . . for those who wear their sunglasses at night.

Monday, April 8, 2013

Small Group Beta.

Tonight I met with Small Group Beta for our biweekly small group session. Now that they are nearing the end of their fourth year, our meetings have become more social than anything else. Now we have what we affectionately call our "family dinners" instead. We meet up. We catch up. We laugh. And, if necessary, we might even cry.

The rule for our family dinners has been simple: Make every effort to be there if you can (as in not on a residency interview or on call.) Let us know if you can't be there. Know that we'll miss you if you aren't there.


And you know? It's worked. Everyone stuck to the rule. Everyone made it a priority.

 That said, like many large families, sometimes it's hard to get all nine family members in one place at the same time. Still we've been fortunate because every time someone couldn't come, it was for a very good reason. Which means that most of the time, nearly everyone is there. And it's comfortable and easy and respectful.  No, not perfect. Just . . .right. Like a family should be.


It's April. Which means that next month is May. And May is commencement month. The month that all but three of "The Incredibles" of SG Beta will graduate and move on to their residencies. Admittedly, the mother in me is relieved for the Masters degrees and research opportunities that have delayed some of them. We agreed to continue having family dinners and to also keep plates warming in the oven for the others should they pass through as hungry interns next year.

This part is so bittersweet, man. Sitting out on that patio with them tonight felt so perfect and right. All I kept thinking about was how unbelievably fortunate I am to be in a position to build these longitudinal relationships with students--particularly those in my small groups. And after seeing Small Group Alpha graduate back in 2011, I know to savor these moments all the more.


Here is what I know for sure:  I'm going to deeply, deeply miss them when they graduate. I already do. But the other thing I learned from my first small group is that these ties that bind us are not easily broken. As long as the porch light stays on they can always find their way back home. And when it's least expected, I'll be placing a warm plate in front of them at the kitchen table.

Just like old times.

My job is magnificent. It is.

Happy Late Monday.

Here's a video montage made up of several iPhone snapshots (and even some video!) starting from our very first day meeting in 2009 all the way to Match Day 2013.  This journey included countless meetings, family dinners, mean mugs, an epic road trip in a ginormous van, and lots more. The song playing on this video is the one on my mental iPod. . . . Madonna singing "Beautiful Stranger."  Why? Because I knew on that first day I met them back in their first year that these beautiful strangers would eventually become a family. 

You know what? I was right.

Small Group Beta from Kimberly Manning on Vimeo.