Thursday, January 29, 2015

Humankind and Kind Humans.

*details of patient changed to protect anonymity

The clinic was busy today. Even though there weren't that many residents in clinic with us in the session, the ones who were there were all seniors which meant full templates of loyal patients. Every room was full and everyone was doing their best to stay on task.

It's difficult not get behind schedule when working in the clinic at a place like Grady. While the medical problems that our patients face aren't necessarily any different than the ones of any other people, the level of socioeconomic barriers are. Getting to us isn't always as easy as hopping into a late model car and rolling on over. Sometimes it means catching public transportation. Other times it means relying on someone else. And other times? We have no idea how the person made it here.

That's what I was thinking today when I walked up to the front desk to sort out some commotion about a late patient. Okay, I guess "commotion" is too strong of a word for this--maybe more like situation since that's mostly what it was. And the deal was this: An elderly woman was at the front desk alone and late. Quite late, actually.

I looked at the clock as I approached the counter. It was past 10:30 in the morning and I'd already been told that her appointment was around 9. Although she was up in age, I knew it wasn't fair to our other patients to not at least investigate things before checking her in. I also knew it wasn't fair to her to not get more details before just making her reschedule either.

Yeah. So up to the front I went. There stood a tiny lady who appeared to be well into her seventh decade. She smiled and nodded when she saw me, exaggerating the deep lines that years of living had pressed into nearly every inch of her face. Her fine white hair was pulled back into a loose braid that curled around the rubber band on the end. The sweater she wore was swallowing her narrow frame, her brown eyes looked anxious and tired. I reached out my hand for hers as soon as I got close enough.

"Hello, ma'am," I greeted her. "My name is Dr. Manning and I'm one of the senior doctors here in the clinic."  Instead of a swift reply, she just sort of stared at me with lost eyes. She did at least reach for my hand and gently shake it. Our hands were nearly the exact same color. Her head did a tiny shake and then she handed her appointment slip to me. This was already pretty obvious to me: she didn't speak any English but I asked anyway.

"Ma'am, do you speak any English?"

She shook her head no. A few moments later I'd learn that she was originally from India and spoke the language of her native state. Fortunately, working at Grady had helped me reach a level of cultural competency where I knew what that was--and even better, of some of our residents who might be able to communicate with her.

I'd assumed I would get lucky since my day had started out that way. A parking space on the third level and a clinic session with several of my favorite residents. I just knew the odds on this day would be in my favor.

That is, until they weren't. Of the several residents in our clinic who speak or understand her native tongue, only one was in the primary care center that morning. I went over to see if he could assist but, in addition to being swamped with his own panel of patients, he admitted to only being able to do enough to communicate with his grandmother every few years.


We do have an interpreter service that is over the phone but something about this lady made me feel like actually speaking to a provider that shared her language would be best. I had pretty much run out of options. The best we could do is put her into a later appointment slot with an afternoon physician.

Trying to explain this through a telephone line was disastrous. She didn't fully understand and seemed to be growing frustrated. She explained that she'd gotten lost coming and had been out since early morning. I immediately believed her, given the anxious look on her face as she spoke. I felt terrible and wished that somehow God would suddenly gift me with fluent Gujarati. No such luck.

The conversation was circuitous and frustrating. The more I talked, the worse it seemed to get. The patient access rep looked at me and sighed softly. "I wish there was somebody who could talk to her," she said.

"Me too," I whispered. I really did.

This was taking so long that I knew I'd need to give my colleague working with me that morning a heads up. I asked her to hold tight for a moment while I scurried back to the doctor room to tell the group I'd be a few more minutes.

"Any luck?" one of the residents asked. Mohammed, though bilingual, is of Pakistani descent and didn't share her language. Like me, he'd gotten hopeful that someone would.

"Nope," I said. "Can't find anybody who speaks Gujarati."

"What about Dr. Khan? He'll be here this afternoon," one of our nurses chimed in.

"I think he's Pakistani, too. Right Mohammed? I don't think that will work."

"Hmmm. Does he speak Hindi?" Mohammed queried. "He may very well speak Hindi. I mean, I don't, but Dr. Khan might."

"You think?"

"I'm not sure. But it is worth asking since a lot of folks speak Hindi in Pakistan, too and he was born there."

"Good to know," I said back. "Thanks."

I trotted back to the front while voice texting into my cell phone to Dr. Khan.

"Hey there exclamation point. It's Kimberly Manning here period. And remote chance that you can speak Hindi question mark?"

His reply was simple and sweet: "Yes. Very fluently. :)"

Now. He didn't have to reply that way, you know? I mean obviously that text was loaded with a favor just waiting to smack him in the face. And favors at Grady usually mean extra work and extra time and extra everything. But he responded that way anyway. And even added a happy face for good measure.


And so the story goes that I explained the situation and my very busy colleague stopped what he was doing to come and help. He sure did. And trust me, he was doing something and not nothing so this was a sacrifice. No, not that afternoon. He came right then and right there. 

Man. I wish you could have seen the look on that woman's face when Dr. Khan walked into that waiting area and spoke to her in a language she could understand. It made my eyes water seeing the relief just wash over her that way. And she deserved that, too. She deserved a chance to be heard.


So lately I've just been thinking a lot about this very simple question: "What's best for the patient?" See, what was best for this woman was to see a provider, if possible, who afforded her permission to speak freely. What was best for her was to not chop her words up into staccato questions and answers muffled through a land line. But. What was best would inconvenience someone. And, on this day, that someone would be my colleague Dr. Khan.


You know what, though? Dr. Khan was gracious and patient. He gave that woman the attention she deserved and was able to get a good understanding of just how lost she'd gotten and why she came so late. He explained her medical problems and kindly helped her navigate our system.

And you know what? It was good. It was really, really good.

I sent him a text thanking him profusely. His reply: "It was no big deal. Happy to help."

And that was that.

I guess today I'm feeling thankful for people like Dr. Khan. Feeling glad for his exemplary and empathic behavior and especially to call him colleague. His caring made a difference for someone. I just know it did. And you know what? If that was my mama walking through a gigantic county hospital all by herself and not knowing the language after missing two buses, I'd hope and pray somebody might do for her what Dr. Khan did for this patient today. Damn, I would.

But you know what? This is the part that doesn't make the news or the headlines in the Atlanta Journal Constitution. But let me tell you--this? This is Grady. A lovely multicultural tapestry of humankind. And some kind humans, too.


Happy Thursday. And shout out to all the Dr. Khans out there.

That made me think of this today. . . . a lot of this happens every day at Grady.

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