Sunday, December 15, 2013


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There are some patients that we discharge from the hospital and it feels so right. Like, there is a family member at the bedside who has appeared with a fresh set of clothes, a coat and a fleece hat for their loved one. The balloons and cards that they and the rest of the doting family had sent fill their arms as the nurse helps the patient into a wheelchair. Out they go. Mylar balloons floating behind them like some kind of flag signaling to all that this part is over. The patient is well enough to go home. And that there is a home to go to.

And when that happens? I don't worry so much. I can't say I don't worry at all but perhaps "worry" isn't the best word. "Wonder" might be good because I do find myself wondering about how they're doing and if they're okay. I open the electronic chart and "chart stalk" to make sure appointments have been kept and medications have been picked up. And the ones who have that kind of support usually quickly allay my concerns with just one glance at the record.

I wish they all had that kind of support.

There was the sweetest man that I cared for a few months ago. His stunning eyes were like two symmetric pieces of amber; I always gasped a little when he looked at me. His skin was a warm chocolate hue and his strong teeth seemed divinely protected from the harsh life he lived. And it was a harsh life. A combination of substance abuse and mental illness had likely peeled him away from his family and, at this point, rendered him without any stable housing.

"How are you today?" I asked him on the last day.

"Me? I am good. Good doctor."  Then he smiled and widened his eyes. I gasped.

"Things look a lot better. I mean, with your health. So we can let you go home today." I winced when I said that part. I cleared my throat and made the correction. "We will be able to discharge you from the hospital."

"That is okay with me."

His voice was staccato. His native tongue wasn't English but he'd been here long enough to have full mastery of it. Admittedly, that part perplexed me the most. It was unusual to see an immigrant person without the balloon-toting brigade. When I saw his name and then met him for the first time I assumed that regardless of how debilitating his mental illness and addiction was, they'd be filling the room sooner than later. Speaking in hushed voices in languages that I don't understand but that would provide me, the doctor, great comfort at the time of discharge.

But they never came for him.

"Where is your family?" It was a simple enough question. I wanted to know. Because this was unusual. It was. And nothing against American families at all. It's just an observation that people who aren't born-and-bred mainland Americans seem to have some kind of family support regardless of the gravity of the issue or amount of their financial resources.

"My family? No family."  And he smiled after he said that. This smile that was either knowing and telling or just completely inappropriate due to the depth of his mental illness. I wasn't sure.

"None? At all? I mean, are they here but you just don't talk to them? Do they want to talk to you?"

"No family."

"Is there something about that question that you want to talk about? Like about your family?"

He shook his head, still smiling.

"Are you hearing voices today?"

"I always hear the voices."

"Are they saying bad things to you?"


I looked at the notes I had written on him. According to social worker, we had arranged for him to go to a nearby shelter after he'd declined a personal care home. I twisted my mouth and sighed. I knew I'd add him to the queue of those that I worry-wonder about and not just wonder about.

"Why don't you want to go to the personal care home?"

He shrugged. "I just can go to the shelter, no problem. No problem I can go to the shelter."

And what could I say to that? I was the fourth member of the team who'd asked him that same question and, like them, was met with the same answer.

And so. We discharged him. Out of the hospital with a seven day supply of his medications and out to a nearby shelter. A ride was provided to be sure he'd make it there and that was that.

Of course, I chart stalked him. When he didn't get his medications, I tried the number he provided and it didn't work. A medical student on my team even called the shelter but he'd since left. So I just kept watching to see what was happening electronically. And surprisingly, there wasn't much activity in the chart.

That was a few months ago. After doing six ward stints in the past six months, my worry-wonder list has grown long. It gets reorganized by acuity and height of stakes so I found him eking down on the list. Admittedly, I hadn't thought of him in several weeks. Plus life goes on, you know? And I am not sure what my worry-wonder capacity is. Even though I think that Grady doctors get added storage when it comes to this.

At least that's what I think.

Yeah, so life goes on. Like life with children and husbands and work and other patients and commitments, too. And on Friday that commitment ended up being a holiday party with a group of children and friends from our old pre-school. I was riding in the car with the kids and they were chattering non-stop about school and video games and sports. And me, I just sat in front periodically saying, "Uh huh, uh huh, oh yeah?" And all was well.

Dusk had fallen and I could feel that the temperature was dropping. The cabin of the car felt cool as we drew nearer to the intown neighborhood where the party was being held. I turned on my seat warmers and also the heat as I slowed down at a red light.

"That man seems mad!"

"What man?"

"That man right there," Isaiah clarified. "He's like he's in an argument but with nobody there."

"Maybe he's just pretending," Zachary replied.

Just then, the man in discussion began waving his arms wildly. He was pointing at the passing cars and then swinging to look over his shoulder, only to start swinging fists in the air. And honestly? He was on the corner and technically harming no one. But it was clear from what I saw that in his mind there was a war going on and he was fighting it as hard as he could.

We sat in silence watching him until the light changed. And just before I pulled off he began to cross the street, still talking, pointing and shadow boxing. I lightly tapped the brake to allow him to pass by the front of my car. And he did.

But just as he did, he turned his head in the direction of my car. And I can't say he looked at me because really, he didn't seem to be looking anywhere. But what I did see was that he was smiling this dichotomous grin that didn't match his aggressive hand gestures. Then the headlights captured his eyes and right then I knew. They were amber.

I gasped.

It was him. My patient from my worry-wonder list. Clearly decompensated with his schizophrenia or very, very high. Or perhaps both. I don't know. But not near any of the shelters and likely not going to one since it was after the 5PM check in time for most of them and since he more than likely was still using.

And that? That sucks. Like, really, really, really sucks.

That's a weird part of this job. The worry-wonder list. You see people and try your best to help but sometimes the enormity of it all is just . . . .yeah. As I drove on and he slipped from my sight, I wondered if there was something, anything right then that I could have done. Like immediately, you know? And since I didn't know what that was, I just said a little prayer for him right then and there and added him back to my worry-wonder list in a higher position. Which maybe was helpful or maybe wasn't helpful at all but at least was a start.


So today I worry-wonder. Which is something I do often. I worry-wonder if he is somewhere safe and if he is okay. I worry-wonder if he became hypothermic and was brought to Grady. (Per the record today, no.) Then I worry-wonder if he came to Grady anyway but couldn't talk so got entered as a John Doe or something like that. And I also worry-wonder if that doting family is somewhere crying and praying and wishing they could find him and blanket him with love and mylar balloons.

I have none of those answers. But I want to believe that there is something good that comes from worry-wondering about people. At least, when you work at a place like Grady Hospital there is. That's what I believe.


Happy Sunday.


  1. Let it be some comfort to you that people like this man have skills and abilities which we will never have nor need (hopefully) fine-tuned from years of the lives they have led. Hopefully, he will continue to use them, as clumsy and as inadequate as they may be, to keep him alive.

    1. That thought actually does comfort me. I think you're right. Thank you, Sister Moon.

  2. This moved me so powerfully. You are a most extraordinary doctor and human. I am so glad there is you.

  3. Interesting point by Ms Moon, and living in DC and seeing homeless folks daily, one that I have internalized as a way not to go insane.

    I use Grady alot as an example when we talk at work about the impact of the EHR program we're implementing, the ACA requirements and funding increases and funding cuts and the impacts and what everything is going to mean. I said the other day -I have a friend who's a doc there. And caught myself. I don't have a friend there -- I read a blog of someone who works there. And just how connected we can all be, here in blogland, here in this little community of folks who never meet and just read glimpses. Thanks for letting me into a glimpse of your world at Grady. It helps me be grounded as I sit here, and wonder what the hell we're all doing sometimes.

  4. I was riveted throughout this post. And then I thought about the Kurt Vonnegut novel "Cat's Cradle," and the expression he made up called "karasse" which basically describes a connection one has with someone in a cosmic way even when you don't really understand what is connecting you to that person. I believe that the man with the amber eyes is now in your karass.


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

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