parable: n. a usually short fictitious story that illustrates a moral or spiritual lesson
The house was beautiful. I mean, just looking at it from the outside you could tell that these people weren't hurting financially. At all. The lawn was professionally manicured and the garden had this intentional spray of blooms welcoming every visitor. And, if that wasn't enough, there was the solid concrete lion that sat at his regal perch right next to the brick walkway leading to an enormous pair of doors. It looked like something out of a fancy home magazine.
We rang the doorbell and the chime totally fit. I imagined some person striking a xylophone to announce our arrival. All of it elegant and flawless. I looked over at my husband and smiled. He smiled in return and added, "Daaaaag. This joint is nice." I nodded in agreement.
"Heeeeey!!!!" That's what we all said in unison when the door opened and we saw our friends standing in the vestibule. Technically, these weren't our super close-close friends and admittedly, this was our first time in their new home. But we were certainly friendly with them since they were friends-of-our-super-close-close-friends. And you know? It was all good from the jump. We felt comfortable right away.
I mean, how could we not in a house like this one?
Of course, we got a brief tour of the home and oohed and aaaahed at every detail. They'd worked hard and, like a lot of people we know, had come a long way. (Although they appeared to have come further than most.) This home was unbelievable. It was thoughtful of them to welcome us for the evening when they heard from our mutual pals that we'd be passing through town.
That evening we had a delicious dinner and then sat around talking and laughing in their exquisite family room. The ceiling was two stories high and the walls were decorated with art from their travels all over the world. That said, we were super comfortable. Everything was so easy and laid back. The libations began flowing and the laughs got louder. We had a wonderful time.
Fortunately, no one had to drive anywhere. Our only destination was up the stairs to the bedrooms. Harry and I quickly buried ourselves in the heaping down comforters and fell fast asleep.
I'm not sure how long I was out before my unforgiving mother-of-two-babies bladder woke me. My head was still a little swimmy when I sat up on the edge of the bed and I had to remind myself of where I was. The heavy cloak of custom drapes was pulled tight. Even if there was daylight outside, it wouldn't have gotten into that room. I waved my hand in front of me but could barely see it. That room was pitch black.
There was a little nightlight on the stand next to me. I started to turn it on but knew that it might disturb Harry. That said, I couldn't see a damn thing in that room. I squinted my eye in the dark and tried to get my bearings on the direction of the bathroom. They'd pointed it out during the tour we'd had earlier but I still wasn't fully sure. I should turn on the light, I said to myself. But, again, I hated the idea of bothering my very light-sensitive husband from his slumber.
When I stood, the plush rug felt good on my bare toes. Even though I still felt a few of those champagne bubbles from earlier, I was mostly okay. I took a few steps toward the bathroom and felt like I was in a cave lined with high end carpet. The smell of lavender and jasmine wafted into my nose and though I had no idea from where it came, I imagined some elaborate candle collection on a nearby occasional table. Somewhere between the big inhalation I was taking and the door threshold, something sharp poked deeply into the ball of my foot.
"Ooooh aaah aaahh owie!" I whispered through clenched teeth. Whatever it was hurt bad enough to cause me to hop in place for a bit and then force me to walk on my heel only. I'm pretty sure I'd broken the skin but wasn't completely sure. By now, I had to pee so bad that I focused on that only.
I'm still not sure why I hadn't pulled out the slippers I'd packed. I guess it just seemed unnecessary in such a swanky house, you know?
Eventually, I got to what felt like a marble floor and heel-walked my way to the toilet. I tried to turn what I think was some sort of fancy dimmer light on in there but couldn't get it to work. I shrugged, flushed the commode and set back out into the darkness once more--still with my antalgic hobble and still with some slight giddiness from those generous glasses of Veuve-Clicquot. My eyes were now a little more adjusted so I could now at least see in front of me.
Suddenly, something flew across the floor in front of me. It ran straight over the top of my foot and disappeared into a dark corner. A massive cockroach? A small mouse? I wasn't sure. Either way, it startled the hell out of me--big time. To make matters worse, when I jumped, I stepped down on something slick and oily. Since my footing was already unsure, up went my legs straight into the air and WHAM! I landed on my back with a big thud. Not only did I knock the wind out of my chest, I also ended up knocking over some candles and lamps and causing a 3AM cacophony.
Lights came on and feet could be heard quickly thumping the floor in my direction. By the time I caught my breath and sat up, Harry and both of our friends were standing over me panting.
"Whoa! Are you okay, babe?" Harry said while reaching for my hand.
"I'm fine. I just slipped."
"Oh my God, girl!" My girlfriend looked at the bottom of my foot and then looked at the floor. She gasped and then looked at her husband. "Did you trip on something? What happened?"
"Uhhh. . .I'm not . . .uh. . . . I'm not sure. I think I slipped or was just. . .uhh. . .clumsy."
Right after I said that, out came that mammoth sized roach thing. It shot across the floor right next to my foot. Both of us ladies jumped behind the door while the guys ran after it with their shoes in hand. Harry's foot slid a little and he nearly fell, too.
We all winced when we heard a crackling sound under the smack of that shoe. I looked over at them and spoke. "Okay, maybe I'm kind of scary and just maybe that little guy is partially responsible for that spill I took."
"Little guy?" my girlfriend said. "Good heavens."
"Oh damn! It looks like this scented oil lamp thing leaked," her husband replied. He looked over at her and sighed. "Since no one had been in this bathroom, I admit I didn't even check again." Then he looked at me. "Damn, I'm sorry, KD. This is super embarrassing."
"Girl, you just missed the edge of that tub!" She clutched her chest and shook her head. "Kim, I had no idea there was oil in here or a leak in this thing. Good Lord. If I had known, I totally would have moved that thing or gotten rid of it altogether. And as for that bug? I don't even know what to say. You could've gotten really seriously injured. I'm so sorry."
"I'm fine. Bugs are stealthy and this is the south. And I also should have turned on the light."
"Your foot is bleeding. Looks like a cut on the side of it." Harry pointed at my right foot. I pulled it closer to inspect it.
"Oh man. Forgot about that. I actually stepped on something sticking from the carpet when I was walking to the bathroom. Felt like something hard plastic. But I thought it didn't break my skin."
"Girl, you are kidding me!" She reached down and picked up a piece of a broken Lego. "I'm going to fuss at those kids as soon as they get back from their grandparents' house."
"It's no big deal. I was kind of heel walking with this foot which is the one I stuck in the oil when our little friend showed up. Pretty much a Murphy's Law kind of thing. It's actually kind of funny."
"Not to me, Kim. I'm sorry, girl." Her usually olive skin was beet red. I felt terrible for her.
After that we were all awake. Our friends looked mortified no matter what we said. Over and over again they kept saying that they were sorry and had no idea that something was on the floor. Then they'd imagine that roach thing and fall silent. They handed me bandaids and towels and kept asking me if I was sure my foot didn't need stitches. I kept saying that it was no big deal and that sutures weren't necessary. I also said repeatedly that I wasn't upset.
Because I wasn't.
"Why didn't you just turn on the light?" Harry said to me later.
"I didn't want you to get upset since you were knocked out asleep," I replied. "I didn't want to wake you up." He rolled his eyes and shook his head.
"Babe. I love you. I wouldn't have cared if you turned on a light, crazy woman. Besides, you didn't even know this house."
"Gotcha. Seems silly now. I should've had on my house shoes, too. Then I probably wouldn't have freaked out so much or slipped."
"Kind of a shock to see a bug in that house, huh?"
"It just affirms what we always say--anybody who hasn't seen one of those things in their home in the south is either lying or they just moved in."
We both laughed.
"Next time, turn on the damn light and put on some house shoes, okay?"
The following morning we were standing in front of our friends' home as we prepared to go to our next destination. For whatever reason, they still seemed embarrassed. Just before getting into the car, I paused and spoke. "You know everyone has those bugs in their home, don't you?"
"You don't have to say that. I'm so embarrassed, girl. We try hard to keep our home clean."
"Ha. Seeing one in your clean, new crib made me feel better about the ones I've killed in my house. They should pay rent, those big ones. It's a bible belt thing. If you figure out a way to never, ever see one, though, let me know." I looked around at their home again. "This is still the swankiest house I've seen this decade."
She chuckled and reached out to hug me. "You guys are always welcomed."
"Great. We'll be back for sure. And y'all can come stay with us, too, although we aren't as neat."
December 1 was World AIDS Day. In honor of that day, I was asked to talk to a group of people in a pretty traditional church that following Sunday about the importance of getting tested for HIV. And then, whatever that test reveals, making responsible decisions with the results. And, yeah, I've done that before in churches and other large gatherings, too. Almost always it comes out preachy and uncomfortable. I can always see peoples' eyes glazing over and body language getting squirmy. Kind of like a teenager who's getting admonished by a parent about something or other that they'd rather not hear about.
Yeah. Like that.
So. I decided to try something new. Instead of lambasting them with scary statistics, I shifted gears to do something that I didn't think church folk would mind so much. This time, I kicked it bible-style with a parable. This parable.
I had their full attention, too. It was awesome.
Then I closed with this. (Or something close to it.)
It's funny how similar HIV is to visiting that house. Just as that house looked spotless, people can look that way, too. We drop our guard when an outward appearance seems to scream immaculate and impossible of tarnish. Slack also gets cut to people that we don't know well when they're connected to people we do know well. You assume nothing could possibly be wrong.
But the truth is that you can never just look at anyone or anything and know anything for sure, can you? So the best thing any of us can do is get to know what you're dealing with first. That said, we're all imperfect. So even though we know better, we don't always make the right choices do we?
Given all of that, there are still some ways to prevent accidents even when we're too impatient to know all the details. First, avoiding anything that affects your judgment is a start. Like maybe not having alcohol might have given me the sense to turn on a light or put on some slippers. And, just maybe, I wouldn't have felt the urge to pee so badly. Or even at all.
If I'd just turned on a light and worn slippers, I could have seen where I was going. And avoided stepping on something that hurt me. With something on my feet, though the bug would have still alarmed me, I wouldn't have been limping and I probably wouldn't have slipped. Especially since I would have seen that puddle of oil from the get go.
Knowing your HIV status and the status of your partner is like turning on the light. No need to guess where you're stepping. Or depend upon somebody else to protect where you've stepped. Because even the shiniest, prettiest, newest, richest and cleanest things have surprises. And sometimes even they don't know about those surprises, do they?
I guess the other thing that stops us from turning on lights is fear of what someone else will say. Like, when I was scared of waking up my husband so bumbled about in darkness. But, of course, we all know that anyone who loves you wants you to turn on the light. As a matter of fact, if they really, really love you, they'll turn the light on for you. Yeah, they will.
Then there's our friends who wanted to disappear after that whole incident. We'd discovered some blemish in their world. But little did they know that everyone has something lurking in a floorboard, a crawl space or crevice that jumps out sometimes. The kind of things that you pay people to come and spray but that still somehow exist in spite of that. That is if you realize there's something that might require pest control maintenance.
I wanted our friends to know that seeing that bug and slipping on that floor and cutting my foot on that Lego made us admire them no less. We were still just as impressed with their accomplishments, glad about our growing friendship and eager to return. And eventually they believed us.
We need to do that with HIV.
Our friends got a good exterminator. And he told them that because they live in the south and amongst a lot of trees, that there'd always be some tiny amount of pests hiding in there. But nothing that would likely bother them or anyone else.
So I guess HIV testing is like turning on a metaphorical light. And seeing a bug when you do isn't the end of the world. It isn't. You just need to know so that you can get into care. Then yes, you'll live with a tiny amount of virus, but it will be so undetectable that it won't bother you or anyone else.
You feel me?
The most elegant homes can have debris in them and an unwanted pest or two. Just like the most amazing people can have HIV. But a lot can be avoided by just turning on the light. Or putting on some house shoes. Or avoiding anything that clouds your judgement. Or makes you greatly feel the urge to go.
What's up in your house? What's up with the houses you sleep in? Do you know your way around? Would you be surprised by a sneaky wood roach or not shocked at all? Are you scared to turn on the lights? And if so, why is that? Is it that you're with someone who doesn't care whether or not you crash into something? Or someone who doesn't even know that there is something to crash into? Or even worse--both at the same time?
How well do you know your own house? What are you doing to protect it? Do you inspect it regularly? Do you allow someone else to make sure everything is okay? If not, why is that? What are you afraid of?
Remember: Knowing isn't the worst thing that could happen to you. Even if you find something. Not knowing always, always is. So turn on the light. Look around. And if you still aren't sure? Or if you're still too scared to turn the lights on?
For Christ's sake--put something on your damn feet.
Yesterday was my last day of my Thanksgiving-month stint of attending on the hospital service. Since November 30 fell on a Monday, my last day awkwardly coincided with the first day for the third year medical students starting their Internal Medicine rotation at Grady. And since the last day of the month before the teams switch is usually a day of tying up loose ends, it's certainly a less than ideal timeframe for any learner to just be joining.
So late in the morning, I joined the team in the workroom and immediately noticed a new face. The moment we made eye contact, the new student immediately erupted into big smile. Which made me smile, too.
"Hey there! Are you the student joining our team today?"
"Sure am!" He stood up and shook my hand. "Hi Dr. Manning! I'm Bailey!"
Now. Let me tell you the first things I noticed about Bailey:
1. He was bright-eyed.
2. He truly looked glad to be there.
Oh, perhaps most importantly, he had what my daddy has always called a "nervous disposition." Let me explain. A nervous disposition is a good thing. It describes this readiness to engage, this body language that conveys being amenable to whatever might be asked of you because that's why you're here. Kind of like the difference between sitting on the edge of your seat with your spine straight versus being sprawled out on the couch, you know? Essentially it's a non-lazy openness that leads to opportunities--especially in the medical education setting.
And that? That I noticed immediately about Bailey. And let me just say that, for the record, I had never heard anything about him before nor had I had any deep interactions with him prior to this. But that very, very first impression I had of him? It was positive. Extremely positive, actually.
So yeah. That got me to thinking. Thinking about learners like Bailey and several others who immediately make it known that they are there to learn. No, not just to get a high grade, but to actually care for our patients and learn.
This is going to sound rambly because I'm trying to flesh my thoughts out here. And though in that very short time I had with Bailey yesterday I adored him, this isn't so much about Bailey. But it is about the individuals like Bailey. Or better yet, for the ones less like him who miss learning opportunities because they don't get this.
And so. That gets me to the "this."
Mmmmm. Okay. So a few years back, I had this student on my team. He was nice and mostly professional. He showed up on time and finished the tasks for which he was responsible and was never rude or indifferent. When I was talking he wasn't texting or yawning. And, for the most part, was fine.
But on the same team there was another medical student, too. And you know? Pound-for-pound the students were pretty equal as far as knowledge base. They were both extremely bright and impressed me with what they knew on a daily basis. But. The second student was distinctly different.
Let me explain. It wasn't a knowledge thing or a nice thing or a professionalism thing. It was just that the second student was a more . . . . gracious learner than the first. Yes. That.
His interest was conveyed through more than just his specifically assigned work product. It was in his body language, his questions, his dedication to trying to understand and learn. And like Bailey, in his nervous disposition.
I remember being at home each night eagerly preparing my teaching exercises for that team. That second student was always at the front of my thoughts. I realized that his level of enthusiasm brought out more in me as a teacher. I tried harder and was more intentional. I came up with creative, new ways to teach old lessons. And every day, he ate it up and asked for seconds.
The other student? He ate it, yeah. But mostly he feigned this plugged-in expression. And, okay, it may be unfair to assume it wasn't authentic but I'd be lying if I didn't say it always felt a little contrived. Like he was doing that because it was what you're supposed to do and not because he truly, deeply cared about what was going on each day.
Does this even make sense?
Anyways. On Friday, a first year medical student I met recently in the med school lobby sent me a text. She asked it I'd allow her to join me on rounds. And let me be clear and place this in context. This was Thanksgiving break for the first year students. It was also a Saturday. My team would be managing patients admitted overnight and it was sure to be a busy, challenging time. But I didn't dissuade her from coming. I didn't because I already knew that, by definition, any student who is willing to come to Grady Hospital on any Saturday--let alone a sparkling, sunny one during a vacation--would be a gracious learner and would add to the learning climate.
I was right.
So I guess this brings me to my point. The most intentionally engaged learners get the most out of any learning opportunity. Without question. Not just because teachers (and patients) will like them more (which is very true) but because of something more than that. Those kinds of learners make teachers better. It pushes us into a zone of development and makes us go harder.
And let's be straight here: That other learner did nothing wrong. But he didn't necessarily nudge me to do anything out of the box or uniquely tailored for him as a learner. And I guess I'm just thinking that even when folks aren't egregiously disengaged, their neutrality can permit you to throw it in cruise control, you know? Working only in the comfort zone and not pushing anything more than pencils instead of envelopes. Mmmm hmmmm.
Which reminds me of something really cool I heard recently. . . .
With Sameer H. and Alanna S., November 2015
One of my former small group advisees, Alanna S., is now on the Emory/Grady faculty. And check it--she was on wards last month and her med student was--dig this--one of my current advisees. Yeah, man. So Alanna from Small Group Alpha spent two full weeks teaching Sameer H. from Small Group Delta on the wards at Grady. And my heart being about to explode every time I saw them isn't really the point of me telling you this, although that was the case for sure. Anyways. My point was something Alanna told me about her time working with Sameer that struck me and, perhaps, sums up all that I've been trying to get at in this uber-rambly post. After telling me about how great it was to work with Sameer, she went on to say this:
"He let me do my best as a teacher."
And that? That is it. Right there. Alanna's gracious learner gave her a gift. A gift. To do her best. And to be her best. And you know? We all have opportunities to do that for people. We can all let someone be great and create a space of them to potentially be their best.
At least that's what I think.
Oh, and I wish I had time to talk to somebody about how conversely our responses to others can also set the stage for someone to do their worst, too. Or be their worst. And, I mean, if I had time I'd unpack on that. That is, if I had time I would.
Anywho. I had this meeting yesterday afternoon on that last day of wards that started at 4pm. But since I knew that I'd only have one day to work with Bailey, I quickly made up my mind to push back my arrival time to 4:30 specifically to give myself more time to spend time rounding with him. And when I did, I initially thought it was for Bailey, you know? But what I now know is that it wasn't. Just in the blink of an eye from shaking his hand in those first seconds, I knew this student would afford me the chance to do my best.
And this? This is something I'll be thinking of for a while. It's something I'll be talking to my small groups and my family about, too. And you know? I'm not sure if this can be taught or even if it needs to be. What I mostly think is that it's already inside of us to be gracious in that way, you know? It's just a choice that can become a habit if we're lucky.
Oh, and if you aren't in medical education? Know that this is really just a metaphor for life and people and relationships. You may already realize this, but I figured I'd say that in case you didn't.
I'm inspired today to try to create environments that let people do their best. My disposition is nervous and I'm ready to jump at the chance to do my part to fan the flames of someone being their best, too. 'Cause guess what happens when you let people be great? It makes you a little greater, too.
Honestly? I write this blog to share the human aspects of medicine + teaching + work/life balance with others and myself -- and to honor the public hospital and her patients--but never at the expense of patient privacy or dignity.
Thanks for stopping by! :)
"One writes out of one thing only--one's own experience. Everything depends of how relentlessly one forces from this experience the last drop, sweet or bitter, it can possibly give."
~ James Baldwin (1924 - 1987)
"Do it for the story." ~ Antoinette Nguyen, MD, MPH
Details, names, time frames, etc. are always changed to protect anonymity. This may or may not be an amalgamation of true,quasi-true, or completely fictional events. But the lessons? They are always real and never, ever fictional. Got that?