Saturday, January 31, 2015

The secret weapon.




The thing about residency is that your growth isn't just related to clinical acumen. A huge portion of it is dealing with people and their personalities. And you have to do all of that while learning to keep human beings alive. As I look back on it, that was one of the most challenging aspects. But you know? Some of my best lessons came from that aspect. Lumpy interactions that helped me learn how to navigate this high stakes job in the midst of not only my own crazy--but the crazy of a bunch of other people.

I've been reflecting on a few of my experiences--and how they helped me to grow. Here is one of them. More will follow.

The One-Upper

There was this woman I trained with who was really smart and highly competent. She had an answer for damn near everything and a lot of the times she was right. And all of that was cool.

But.

She also liked to be the person who'd been to the mountain top before everyone else. She seemed to take enormous pride in superseding whatever it is you saw on call or did on your rotation with some far more sexy experience that she'd already had to trump it. And you know? It was annoying. Annoying as hell.

I've always loved medicine since starting my training. I like to think about it, talk about it, revisit things and hash them out. I like to sort out aspects of a clinical story and try to piece them together. And back then with my learning trajectory going skyward, there was always much to debrief on. The highs, the lows, the wows and the OMGs. Mostly I'd do this with my friends, which this particular woman was not. But what many folks will tell you is that residency is kind of like boot camp. Ward teams are like the folks in the barracks with you and often out of necessity you share when your lives overlap for whatever time that is.

And so. One month in my second year of residency, I was placed on the same team as the One-Upper. And I will just give you a spoiler alert and tell you that it didn't end too well.

Ugggh.

We were in the Medical Intensive Care Unit that month. That's a place where the sickest of the sick come for care and the call nights have the most action. Well, the way our schedule was set up, our call days were like two days apart--that is the One-Upper and myself. So whenever I was post call and trying to sort out my patients and their problems, she loved to position herself next to the attending and fellow like she was my boss, too. She'd stand there with folded arms, feeling all super rested from being home the night before-- in contrast to my up-all-night hotmessness and scatterbrain to boot.

One night, I'd gotten this patient who was profoundly anemic for multiple reasons. Due to her hemodynamic instability, she'd been placed in an ICU step-down bed which, at our hospital, was managed by the ICU team. For us, step-down patients were like a breath of easy, fresh air. I figured I'd tank this patient up with the blood that she needed and would have her ready for transfer out of the unit in no time.

So check it--I'd given her a blood transfusion and, much to my horror, like two hours after she received it, she developed severe respiratory distress. Like severe, severe respiratory distress. This was not a woman with a ton of medical problems before hand either. It was terrifying.

Her respiratory status was so awful that she required intubation. And her blood pressure fell even lower than it had been before. And so. We supported her breathing with the ventilator and lots of oxygen and also pumped her with some fluids. Given the time frame of the symptoms, I decided that this might be something called TRALI--transfusion related acute lung injury.

Well.

I'd only read about TRALI. This was all academic as far as I was concerned, so I simply did the best I could given the circumstances. And fortunately, by the time the morning came, my patient had taken a turn for the better.

My attending studied the nursing notes and vitals for a moment as I presented the overnight events. "Wow. So that was pretty sudden. These MAPs (mean arterial pressures) are in the basement," he said.

"Yes, sir," I replied. "We started the pressors fairly early since we didn't have much reserve. She was already on the low side to begin with."

I saw the One-Upper shifting from side to side. I knew she was about to say something so I braced myself. "What about steroids?"

I just sort of looked at her and paused for a moment. "Um. Well, mostly what I read said you start out with supportive care."

She stopped talking to me and sort of shifted toward our attending. "I don't know, boss, what do you say? I've seen some good results out of these guys when you hit 'em with a little SoluMedrol."

Oh have you?

"Eeeeehhhh, you can." He studied the chart a little more. "Mostly it's all supportive but yeah, steroids are often given."

"I'm a fan of the steroids," the One-Upper chuckled. Then she turns to the medical student rounding with us and says, "So the patient has acute respiratory distress right after you've given a blood transfusion. We already talked about transfusion related acute lung injury. What else could this be?"

The student floundered a bit and threw out a few options. I felt my face getting hot. Partly because I was tired but secondly because I was tired and this woman was irking the heck out of me.

"Taco," she said with a smarty pants grin.

"Excuse me?" the student said. I could tell that student was wondering whether or not she was speaking of Tex-Mex for lunch.

"TACO," she repeated. "As in Transfusion Associated Cardiac Overload." She looked toward me and asked another question. "Dr. Draper, did you consider a touch of Lasix just in case?"

Let me be clear on something: The One-Upper woman was my PEER. We were at the same level and in the same residency class. And today, she was pissing me all the way off. While my attending allowed it.

"In case of what?" I responded flatly. I hated that she addressed me as "Dr. Draper" like that. A lot of attending physicians would do that. But fellow residents never used such formality unless they were standing in front of a patient.

"In case it's not TRALI and it's volume overload like TACO." I could have sworn that she twisted her neck when she said that part. I glanced to my attending hoping he'd get my cue for him to shut her up. But he kept studying all the overnight event recordings and didn't say anything. When he didn't, she launched into another spiel on TACO and how this could have been that and how it is actually indistinguishable from TRALI. She even sort of nodded to me when she said that as if I was also her medical student. She started to say more and I cut her off.

"She was hypotensive." My voice was flat. Irritated.

The One-Upper paused for a moment. Then went on, "Well, Kim, you've not actually seen both conditions clinically but I have and--" she turned back to the student--"they both present with respiratory distress so they're indistinguishable." Her tone was so condescending. I tried my best to be subtle as a took  drag of air through my nostrils.

"Hypotension," I repeated, this time with what I know was an attitude.

"Mmmmm. . . . .Well, actually the blood pressure in--"

I cut her right off. "They are distinguishable. One gives you really high blood pressure and one bottoms you out."

She squinted her eyes and tapped her lip with her index finger.  "I'm trying to remember what my last patient with TACO looked like blood pressure wise."

"Hypertensive," I shot back. Then I took a clear swipe which was immature, I know. "That's how she looked. And if she didn't, your diagnosis was wrong."

"Somebody sure is post call snarky!" the One-Upper replied with a snort. Then she turned back to our student and put a hand on her shoulder. "When you really see a patient with transfusion related respiratory distress, you'll be just trying to keep them alive in anyway you can."

My face was hot. Thank goodness for melanin because I know it would have been beet red otherwise. This had been going on all month and I had been up all night. I decided to clench my jaw and just shut up. Finally my attending decided to climb from under the chart and chime in.

"Well, that's true. . . but Kim is right about the blood pressure being the hinge that swings you from one diagnosis to the other. TACO occurs because of a massive upswing in the blood pressure." He yawned and swirled the tepid coffee he'd been nursing all morning and took a little sip of it. "Looks like things are  going in the right direction for this patient. Who do we have next?"

And that was it. That is for that patient, it was. That same thing happened four or five more times on rounds. And each time, my blood boiled just a little more. By the end of rounds I immediately walked off the ward to get away from her.

Yeah.

But everyone knows that when you really, really need to escape this kind of person they somehow keep popping up in your personal space. I was writing the last of my notes in the corner of the physician team room when the One-Upper came strutting in with the medical student behind her.

"Heard you ran two codes last night. Pretty busy," she opened up in my direction.

"Yuh." I kept myself busy, nose down in the chart and hand writing feverishly. My fuse was short and I knew I needed to get away from her before I lost it. I was also totally exhausted.

"I had a guy with a horrible pulmonary hemorrhage a few calls ago. Thank goodness I was able to position him to keep him stable until the Pulm team arrived."

"Yuh."

"Did both patients make it?"

I looked up and rested my eyes on her. I knew she knew that one had expired and one hadn't. But she asked anyway. I'd had enough.

I laid my pen down in an exaggerated slap. "Why are you asking me that? Like, why?"

"I was just wondering. Sheesh."

Her pseudo-innocence was making my head hurt. "No, you weren't. You heard me debrief with the fellow and you knew that one passed away and one didn't. So what I want to know is why are you asking me this?"

She put her hand on her chest and acted like she was surprised. "I-I-I I didn't know that--"

"YES. YOU. DID." I turned to medical student. "I'm sorry for this. I'm just really tired."

She awkwardly mumbled that it was okay and then excused herself, which was probably smart. Now it was just me and the One-Upper. Before she could speak,  I just shook my head and asked that she leave me alone. But she just couldn't respect that request.

"I just don't understand why you have to be so hostile. All I asked was a question."

I closed the chart and stood up. Against my better judgement, I spoke. "Did you just say hostile?"

"I mean, yeah. I asked one thing in small talk and you got all hostile."

"No. You didn't just ask a question. In fact, you never do. You just. . . " I wiped my face with my hand, sat back down, and sighed. "You know what? Just leave me alone. Please. Just go away."

She just stood there staring at me. Like someone had frozen her or something. "This has happened to me before in med school. People feel intimidated when someone smart comes along. Usually it's men who have the issue. But I guess this time it's a fellow sister."

"What?" I whipped my head over at her and crinkled up my face. That's when I knew I needed to remove myself. Which is exactly what I did.

Yup.

I called my dad and lamented to him about her. He listened and then said, "Why is she able to take over so easily when you have the floor? You need to think about that." That was pretty much the gist of what he said. I thought about it all night and throughout the following day.

That was enough inspire a new strategy. For the rest of the month, I spent at least one hour reading on every one of my call nights. I showered, changed into clean clothes instead of scrubs and arrived as ready as I could for rounds after those overnights. Instead of looking haggard and beat down, I coached myself to be the exact opposite. I countered her one-upmanship with excellence. And man was it an awesome weapon.

Yup.

What I learned from that experience was that it didn't even matter whether or not she was being an asshole. I'd given her space to step on my toes by not being excellent. In my head, I'd convinced myself that looking broken down would translate to how hard I'd worked and gain me some kind of badge of honor. But what it did was give someone room to usurp my presence as a competent clinician and teacher.

So I guess that's what I'm reflecting on. Excellence as a secret weapon. Instead of getting angry, I bleached and starched my white coat, shined my shoes, and prepared. I looked my attending in his eye, tried to anticipate his requests, and covered my bases. It was much more empowering than all that huffing and puffing I did before.

Yup.

Eventually, she stopped trying me on on rounds. The fun of it was gone. My buttons weren't pushable thanks to the perspective my dad had given me. And look---I have no idea what's going on with any of you in your lives or on your jobs. But let me just say this: When plotting your attack, consider just focusing on being more excellent. I can't say I always get it right, but trying at it makes a huge difference. Excellence is the pièce de résistance that shuts the haters down every time.

And even when it doesn't, trying to be excellent takes up so much energy that you won't even have time to care.

Yeah.

***
Happy Saturday.

Friday, January 30, 2015

That, too.

Zachary this morning


I lay my hands upon them each morning. Together we petition for protection, good choices, a mind prepared for learning and a heart prepared for accepting. I let them hear my voice and feel my touch, hoping somehow it will speak to their young spirits.

We say amen and then I say the same affirmations just before the bus or the carpool pickup arrives. They know them so well that it probably feels a bit like Groundhog Day--which is alright with me. That said, this morning with Zachary was just a little different.

6:48 a.m. this morning

"Who are you?" I started.

I secured his hood and skull cap onto his head.

Zachary replied like clockwork, "I'm the head and not the tail."

His coat zipper stuck for a bit and I helped him get it going.

I went on without missing a beat. "Exactly. And what else?"

I checked his backpack to make sure he had his folder and courier, spinning him around like a little top.

"I'm a leader and not a follower."

Now he was facing me. He perched his chin forward so that I could pick something from the corner of his eyes that we'd missed.

"That's right. And what else, son?"

We pulled on the bottom straps to tighten them around his shoulders. He grabbed each one with both hands to make sure they were secure and gave them a firm tug. Then he looked up at me and smiled like always.

"I'm a child of God and I can do all things through Christ who gives me strength."

"Yup."

Next, I started into the rest of my every morning-last minute diatribe that probably comes out more like one of those announcers telling the side effects at the end of those pharmaceutical commercials than anything else. "Make good choices, okay? Follow your heart, alright? And always choose kindness. Always, okay?"

"I know, Mom. I will, Mom."

Just then the bus pulled up with its blinking red lights.

"Okay, buddy. Make it an awesome day."

He started to light out toward the bus like always but stopped short to say one more thing.

"Hey Mama?"

"What's that, bud?"

"You know what else I am?"

I felt my heart beginning to swell in anticipation of whatever sweet little punctuation my boy would have on our exchange before starting his day--especially since he'd started it out by calling me "mama." I pulled my jacket closed to hide the pajama shirt I was wearing underneath and cocked my head sideways.

"What's that, sweet boy?"

"I'M A SEAHAWKS FAN! OH YEAAAAAAH, BABY!!! WAAAAHOOOOO!!!! LET'S GET IT, BABY!!!!"

And with that, he leaped onto the school bus, gave the bus driver a fist pump (I kid you not) and then disappeared down the aisle with his gigantic backpack bouncing behind him.

Well. Yeah. I guess he's that, too.

***
Happy Friday. Let's hear it for those 'Hawks and my little 12th man.

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.

Bummer.

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.

Yup.

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.

Yeah.

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.

Yep.

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.

Yeah.

***
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.

Writer's Haiku on a Thursday.





words swirl in my head
they coalesce, come alive
writing gives me life


***
Happy Thursday. 


Wednesday, January 28, 2015

Air Apparent.




And I think to myself, "What a wonderful world."


I've had some great runs over the last year and a half--complete with some epic jump photos to remember them by. I'm so glad that my friends are such great sports and willing to participate in my post-run shenanigans . . . . even after running 13.1 miles. What can I say? It just never gets old for me. 

LIke ever.

This crazy running adventure started as a way for me to rage against heart disease after my big sister passed away. Since heart disease is so ruthless, every step and every medal feels like a chance to answer back. Each finish line is me saying, "In yo face!" or "Take that, heart disease!" And sure. I know I don't really have full control over it but I like feeling that way for those few moments. It makes me feel like there is something I can do, you know? Writing has felt that way, too. I know it's probably silly sounding. But loss can leave you feeling so helpless, so . . .so. . . .  silenced you know? 

Yeah.

Here's what I'm thinking about right now: I love having legs that can run, a heart that is pumping, a mind that is aware and that remembers, and eyes that can look ahead to my goals. . . .and then using them all in concert to put big accomplishments behind me. That's something to jump about, don't you think? I sure do.

So much is going on in this world. So much. Sometimes catching a little air under my feet makes all the heavy things feel lighter. If even by a little smidgen and only for a tiny moment. But mostly it reminds me that I'm alive, man. And that I'm still here.

Yeah.

***
Happy Hump-Day. I'm here!

Now playing on my mental iPod. . . . as sung by the incomparable Eva Cassidy.

Tuesday, January 27, 2015

What it's like.


It's like saying your Easter speech and getting a standing ovation from the whole congregation--even when you didn't get all of the lines right.

It's like coming home from college with your University sweatshirt on and noticing a glisten in the eyes of the proud elders when they see you.

It's like the first day of school and the last day of school--but at the same time.

It's like riding your bike without training wheels for the first time down the big hill.


It's like the gigantic Christmas Day crossword puzzle in the New York Times or the Atlanta Journal Constitution that seems impossible to solve. But that you stay at all day and all night because some piece of you believes that it can be. And should be.

It's like that feeling that wells up in your chest when you hear someone hit the biggest notes in a gospel song.

It's like coming home from summer vacation and learning that your very best friend on your block has moved away for good.

It's like dancing in rain; you get soaked but it feels good and right.

It's like loud music booming from the speakers of a souped up muscle car but also like the symphony, too.

It's like running to the top of those stairs like Rocky did and finally reaching the top out of breath.



It's like locking your keys in the car and not having any idea how you'll get them out.

It's like being given the key to a diary every day and being trusted to read it, carefully lock it back, and keep the contents hush.

It's like watching someone throw dirt on top of a casket of someone you love.

It's like going back in the bathroom to check a pregnancy test and finding out it is positive.

It's like going back in the bathroom to check a pregnancy test and finding out it is negative.



It's like sitting next to your daddy in his Lincoln Continental as he plays Donny Hathaway singing "Young, Gifted and Black" for you on the tape deck. And not moving because he admonished you to soak up every word.

It's like re-listening to Dinah Washington singing "This Bitter Earth" as an adult--another from your daddy's collection--and this time actually having something to relate it to.


It's like the sting of a bad, bad breakup.

It's like the euphoria of brand, new love.

It's like the hug your mama gives you after you've fallen and skinned your knee.

It's like the hug your sister gives you after that bad, bad breakup.



It's like the angst of waiting for the school bell to ring when you know a fight awaits you on the playground.

It's like the long walk home with a bad report card.

It's like finding out you're going to DisneyWorld.

It's like the rap song you know all the words to coming on the radio--and not caring that people laugh at you while you recite each word.

It's like missing your plane right after the doors close.

It's like making your plane right before the doors close.


It's like morning yoga on a crisp autumn day in the mountains.

It's like coming home and seeing flowers waiting for you on your doorsteps.

It's like the sun; sometimes too hot, but usually welcomed.

It's like feeling the hand of God sometimes. Even if you're someone who isn't so sure what that means.



Someone asked me what it's like to be a Grady doctor. And at that time I was at a loss for words. But now? I'm not.

Honestly? It's like all of these things, which are really just the rhythm of life . . . . with its ticking metronome of high-highs and low-lows. Yes, that. 

I doubt that the person who asked me will ever read this. But I will. I will read it again and again and again.

Yeah.

***
Happy Tuesday. Again.

Now playing on my mental iPod. . . . first Donny Hathaway singing the song my daddy played for me in middle school that I can't wait to play for my own children. So life affirming.



Next, this. . . .Miss Dinah Washington singing about pieces of the what I see each day. . . .




.  .and last. . .gospel singer Yolanda Adams hitting the big notes and taking the wind from my chest. Just like so many of my days at Grady.



This American Life in Pictures: Powered by love.


Martin Luther King Day.  I was driving the carpool after our service project and paused to get a selfie.


Or two.


Isaiah is a huge Cam Newton fan. His auntie JoLai sent him a jersey and wanted to know if he liked it.
                                                                                                                                                                                                                                                                                                                                                                                                                                                                



That would be a yes.

And OMG this:





One of my former students from Small Group Alpha, Alanna S.,  INTERVIEWED for a faculty position at GRADY last week. So she could end up working along the very same halls shoulder to shoulder with you. . .the same ones you took her to as a first year student to place her stethoscope on a real person for the first time.

Here she is as an intern. . .just a few months after graduating from Emory. How sweet is this?


So very, right? Oh and this:


This is the resident conference that has become my baby. Instead of one 50 minute lecture, we have five 8 minute mini lectures from resident physicians. It has been absolutely amazing. We call it "BST Mode" for "bite sized teaching" mode. Go ahead. You can say it. "Damn that's clever."


video


Here's the video message I had my resident show to Sweetie before he left the hospital. I was so happy to see him when he came to his follow up appointment. He's doing great. I'm realizing that little things that show people we care and are thinking of them can go a long way. I'm SO proud to be a part of his care and in awe of the bravery of him and so many of our patients at Grady.

What else? Oh. This:



My yummy rigatoni carbload before the most recent race. Light with lots of bright colors like the location of this destination half marathon. . . 



. . .Miami! Can you believe that this was the view from our hotel balcony? This photo was literally taken over the weekend. Blasphemy considering the wintry blast going on up north.


So much fun to travel and run with The BFF Lisa and Free-Free for this one. Those two are loads of laughs and great at motivating you on the tenth mile on.


We call ourselves "The Beastie Girls." Even had shirts made for this one. Ha.


This was my 6th half marathon. 6TH!! Can you believe that? All I kept thinking was, "I can do anything, man." I love knowing that my running is powered by love. Love for my sissy and my fight against heart disease.


I did my mile dedications as always. They were as follows:

Miami Half Marathon 1/25/15
  1. Me
  2. Harry
  3. Deanna
  4. Zachary
  5. Jackson, my godson
  6. My patients at Grady
  7. Poopdeck
  8. Isaiah
  9. My sorors of Delta Sigma Theta
  10. Tounces aka my mama
  11. JoLai
  12. Will
  13. Deanna 
Oh, and the last 0.1 is for ME. I always type them into my notes on my phone and memorize the list. I kid you not, I talk to the person whose mile it is when I get tired (which is a lot.) And I always cry when I cross the 12 mile marker because that last one is "The Deanna Mile." I tear up every single time and I ask her to loan me her angel wings so that I can fly.



And she always does.



She loaned them to my fellow Beastie Girls, too. How awesome are these beach jump pics? 



And this pic of my friend Tamika is from another race here in Atlanta. The jump pic tradition has gone viral. When I look at them, I'm always reminded that I can do anything if I can leap like that after running that far. I love feeling strong!



This was our situation after running 13.1 miles in Miami. Not a bad deal, man.


Not to mention some awesome time yucking it up with my girls. Can't beat that.


Oh! And this. Some snaps from this INSANELY amazing evening I had a couple of weeks ago. 


I was awarded this really cool award called The Clutchwoman of the Year given by P.Sherrod and Co. As a part of the awards reception, I was asked to invite 6 of my "clutch women" from different aspects of my life. 


I invited Lisa, Ebony, Joy, Marra, Frieda, and Shaton. I got to sit at a table with them and hear kind words from them--but also tell each of them why I thought of them as women I turn to in the "clutch" situations. 


It was so cool to have a "mash up" of my Ruths who normally aren't all in one place at one time like this.  

P. Sherrod and Co. is a fine handbag and accessories designer. Would you believe that they gifted me with this insanely awesome collection of clutches and handbags? It felt like it was my birthday even though it wasn't. 




We had a great time celebrating together. And can you believe that I got up the next morning and ran ten miles?


I would not recommend that to anyone. Especially after the night we had. Talk about the LONGEST long run EVER.

Ugh.



Oh. And speaking of "ugh." . . . 

This was the look on my face when the person right by me on the plane to Miami had air sickness and kept-kept-kept upchucking into that little bag they furnish you with behind the seat in front of you. And can I just say that I think there needs to be some rule on how many times you can vomit into the same bag. Or at least open the bag once you've vomited in it. 

Sorry for my non-doctorly empathy. I just don't do well with vomitus. 



To get us off of that, here's a snapshot with one of my new clutches in Miami. Was feeling pretty swanky and Miami-ish.


And lastly this. . . Zachary in the jacket he received at the end of his football season that he has not taken off since getting it last weekend. . . . followed by another snap with one of his number one fans--his brother.




Lots going on in this American life. . . . lots. Exhausting? You bet. But good. . .and all of it powered by love.

Yes indeed.

***
Happy Tuesday morning. Missed y'all.

Sunday, January 25, 2015

Sweetie.



He'd been in the hospital for what felt like a million years. The complicated problems we treated him for required lots and lots of invasive interventions. He'd take a step forward but then there would be a setback. And we'd be back to square one.

Ugh.

That said, I loved seeing him each day. His attitude was mostly positive and, at least when I saw him, he was cheerful on most days. Whenever I greeted him, he'd respond by calling me "sweetie" which I loved. I really did. And after so many days of him calling me "sweetie," eventually I started calling him "sweetie," too.

One day it was recommended that a big meeting take place to figure out his discharge plan. The medical doctors were all there along with the social workers and case managers and pharmacists, too. And everyone was talking and thinking and pow-wowing on how to help get him out of the hospital safely. That discussion was pretty discouraging, too. Not even so much because of the nature of his medical problems. It had more to do with his very unstable living situation and lack of family support.

Yeah. That.

So we talked and talked about Sweetie and tried to come up with some way, some how to get him safely discharged. But it all kept feeling like a gamble no matter how many permutations of gameplans we developed.

"We could have him get some home health visits. What do you guys think about that?" one person would say.

"But he doesn't have a home for someone to visit."

"Oh yeah."

"What if we had him go to a personal care home?"

"But he has so much equipment to take with him and so much stuff is still connected to his body. I'm worried that it would be too much."

"A nursing home?"

"I guess maybe at some point. But this isn't really long term and he has a lot of unique aspects that might make a nursing home gun shy about taking him on," another countered.

"He also has no funding which makes it even harder."

Which was true.

Ugh.

So eventually Sweetie got well enough to get some of those lines and drains disconnected from his body and he seemed to be going in the right direction. By the time all of this happened, I was off of the service, but since everyone knew I was invested in him and his progress, I was told immediately when a plan was finally made to discharge him. On the day of his discharge, I sent the resident a video message to show him. I wanted him to feel encouraged that he'd be okay.

"I hope he comes back," I said when my resident notified me of his discharge.

"I hope so, too," she replied softly. But then she added hopefully, "But you know what? He's following up in one of your resident clinics. So maybe he'll come, you know?"

"Did you show him the video message?"

"Sure did. And he was smiling from ear to ear." And when she told me that, I was, too.

Outside of a few of the more complicated aspects of his medical problems being taken from the equation, his living and resources were still very much shaky and worrisome when it came to things like keeping follow up visits. But eventually, the bullet just had to be bitten, you know? And no matter how careful we are with every single thing, there are just so many little, bitty things that we cannot control. Like, at all.

Nope.

And so. I guess I am writing about him because this is an age old story if you work in a safety net hospital like Grady. You care for very sick human beings with all of your might, you learn their stories and begin to really, truly care about them. You root for them and wish that there was just some way that you could safely put them inside of your pocket to protect them from all of the hard things that can't be fixed by our order sets or allayed through the power of our prescriptions. And when they leave you, you still worry-wonder about them--hoping and praying that the pieces will fit together and they'll find their way back to you.

I wish I could say that the patients always did. I wish I could. But I can't.

When I looked into the computer and saw that Sweetie had been given an 9:20 AM appointment, I groaned out loud and smacked my face with my hand. "Ugggh!"

"What?" a nearby intern asked.

"It's just a patient that I'm scared won't make a follow up but needs to. And 9:20 on a Monday at Grady is hard."

"Not if he knows somebody who cares about him is here waiting for him."

And that was all that intern said which stuck in my head like a very, very stubborn piece of gum on the side of someone's favorite shoe. I quietly thought about that idea--someone caring about you--and what that means to everyone in everything that they do. And suddenly I felt hopeful.

Let me be clear: Of course, most of our patients have scores of loved ones who care about them. And even those who don't have many people, care enough for themselves to slug it out. But I've learned from my experiences at Grady and also just through living that mattering is everything. And I hoped with all of my heart that Sweetie knew that it mattered to me if he kept his appointment with us. I really, truly did.

It's heartbreaking when it doesn't work out. Such a sinking and defeated feeling when you keep refreshing the screen and hoping that the heavens somehow opened up and dropped your patient into the waiting area. Especially the ones that have permanently stolen a piece of your heart and who you believe needed you as a surrogate shit-giver.

Sigh. I'm rambling, I know.

But yeah, it sucks when you leave it all on the field and lose. And it hurts when you worry and wonder and worry-wonder for weeks and you call a disconnected phone or look for some sign that your patient has reappeared in the system somewhere. But they haven't.

But you know what else? It's exponentially more awesome when it does work out. Man, it is. And Sweetie came back. Despite how hard it was for him, he did.

"Sweetie! You made it!"

"Yeah, Sweetie. I sho did. I had to come see y'all so you wouldn't be disappointed."

"Will you keep on coming to see us?" I asked.

"Yes, ma'am. The young doctor was calling me and everything. And they showed me the message you made me. Coming up here is good for my body getting healthy but it also just feel good to know somebody worrying theyself about you."

I felt my eyes stinging and just rested my chin in my hand.

"I do worry myself about you, sir."

"I know you do. And you know what? That make a difference. It do."

"For more than just you. It makes a difference for me, too."

"I know that, Sweetie. I know."


Best. Job. Ever.

***
Happy Sunday.

Tuesday, January 20, 2015

The considerers.




"People who need people are the luckiest people in the world." 

~ Barbra Streisand

When I was a resident, every now and then I'd get a phone call from my chief resident asking if I'd be willing to switch a call or swap an assignment with someone. Sometimes it was because a person had an illness in the family or some other unforeseeable issue. But you know? A lot of the time, it wasn't that. It was just because of some snafu or simple human error that could only be remedied by another human being willing to be malleable.

Now that I'm a full grown faculty member, that still happens all the time. And just like in those days, it's still a huge relief to finally secure a finger in the dike of whatever counts as your last minute leak. So as far as that goes, there's truly nothing new under the sun.

Nope.

I will never forget the day I was trying to put out a fire with one of my co-chief residents during our year together. We were looking to fix a hole in the schedule after a resident struggling with depression had been given some much needed but sudden leave. And see, something like a person needing coverage for self care, specifically the kind of highly personal care associated with mental health, is always tricky. We'd been scrambling around all morning to find someone and hadn't been lucky at all. That is, until finally, one of the second years came into the office and said, "I got your page. What's up?"

"We have a situation," my co-chief said. "I won't even sugar coat it. We badly need someone to take a ward team for April. I know you're on elective but due to an unforeseen circumstance, we are without a resident."

"Wow. Is everything okay?"

"It will be," I chimed in. "Thanks for asking."

And so. That second year resident stood in the door way squinting his eyes and looking skyward. Then he reached into his white coat, pulled out a tiny calendar book and flipped the pages to April. Slowly he ran his finger tip over each day, making certain there wasn't a conflict. "Can I make a quick phone call before giving you an answer?" he asked.

Our eyes widened in disbelief and in unison we responded with eager nods. And with that, that R2 disappeared around the corner to use a phone at the program coordinator's desk.

"He's gonna do it," my co-chief said.

"You think?"

"Yep. If he can, he will."

"You know? You're right. It's funny. Some people are just considerers and some just aren't."

I'm not even sure where I got that from--that term "considerers." But when I said it, Jeff smacked his hand down on the desk and said, "Exactly! Exactly! Some are considerers and some just aren't. Yes. That. That!" And we both just laughed and laughed because, after an entire morning of being met with "non-considerers" we knew that no words could be truer than these.

Nope.

So here's what got me thinking about that this morning. Last night I was working on my spring schedule. It's really pretty crazy--lots of speaking engagements and two major national meetings, one of which isn't even in the U.S. (Okay, which technically makes one of them inter-national, but you get the point.) My children with their crazy schedules and, of course, my career as a clinician educator.

Oh yes. That.

Well. In this whole process of securing hotels and making plane reservations and colleague coordination and sending in materials, I discovered a conflict. And not just a little conflict-tito, either. A major faux pas that would bust my groove--especially since I've not yet mastered the art of being in two places at one time.

Ugh.

So I study the master schedule and start trying to think. And by think I mean figure out who-who-who might be able but more importantly willing to help a sista out of her self-inflicted rut.

Now. Of course, I looked first to see what all of my friend-colleagues had going on during that time. When friendship is involved, the considerer card doesn't really need to be played because consideration comes from the desire to simply help out a friend in need. But, in this instance, I could see that every one of my own "go to" people were already out of the question.

Bummer.

And so. I looked to see who specifically might be able to work during that specific time. I shot off a few very late night emails and went to sleep hoping for the best.

Now. This morning, I had already received three responses. And you know? All three of them warmed my heart and made it sing a little bit. Because all three of the people who responded to me were, like that second year who'd come in person to see how he could help, real, true considerers.

Yup.

One said, "I just need to check a couple of things on my schedule and think I may be able to help you. Give me a couple of hours."

Another said, "I will actually be at a conference for part of that time, too. If I can cover the part you need and maybe arrange a three way swap with someone else, I could probably do that."

And lastly this: "Hey Kim--just want to make sure I have the dates you need correctly."

So I replied to all of them including the last person, to whom I gave the precise dates. And you know what? Two minutes later she replied:

"Okay. Happy to help."

That's it. That's all.

Sure. Maybe what I needed worked out swimmingly well for the schedules of two of these three people. But you know? I somehow doubt it. Moreover, none of the people I asked are the type that anyone could walk over or railroad into doing something that really isn't rational for their current work load, either.

But they were considerers. People who genuinely look at your problem, consider who is asking and the circumstance, weigh their options, and then truly give real thought to their ability to help--even if it involves some slight inconvenience on their part.

This isn't just with work either. It's across the board, man. Like, in life, some people are just considerers and some aren't. My mother? She is the ultimate considerer. She is. And Lord knows--my mama is no milquetoast when it comes to standing up and doing things on her terms. But damn, she helps us out. I'm talking big time, she does. And when she can't, she just can't.

But can't is different than won't. Yes. That.

See, considerers usually tell you no when they can't do something. And sure, that can't can be a very person thing like simply being tired as hell from a long work week or having some plan already that can't really be changed or even something that is altogether none of my business. But mostly considerers will at least sit for a moment and actually think it through. Without automatically saying no.

Now.

Conversely, there are some really good people out there who just aren't considerers. They just aren't. Sure, they reply to your email with some heartfelt-ish words of apology (that is, if it was sent as an individual request) but mostly whatever is requested is met with silent indifference. Or, at least, what feels like that.

I do believe in drawing lines and trying not to get too overextended. I don't recommend always being a yes man or woman, nor do I think folks should be human doormats. Nope, I am not exactly keen on always looking out for those who don't ever-not-ever look out for others people. That has to be factored in there somewhere, you know? Yeah, so regardless of all that--this morning, in particular, it's simple. I'm just deeply appreciating the people in my life both personally and professionally who are considerers, man. I am. Because we all need help sometimes. Help that inconveniences or puts someone out of their way. And without them--the considerers--those who need the considering will always be in lurch..

You know? I really try to be a considerer. I do. Our lives and worlds can become so self-centered though that it's a work in progress. For some people, that's always come naturally. I admit it hasn't always for me--when I was younger especially. Sure, I looked out for my friends, but that was mostly it. But the older I get, the more I've come to see how critical it is to have people who are at least willing to TRY to come through for you in the clutch. And you know what else I've learned? It actually does your heart good to be the person who DOES come through for someone else.

Yup.

Deanna? Oh, she was the ultimate considerer. Anyone who knew her would tell you that. (And okay I did say that my mom was the ultimate considerer but let's just say they're in lockstep for that distinction.) Deanna? She'd pick your kids up in a pinch, help with whatever she could, and just go out of her way, man. My sister JoLai is this way, too. And even though, like my mom, her no meant no--it was never an empty, faceless no. The request had been at least spread out on the table, placed on a mental post it note and . . just. . .considered, man. Considered. 




Today, I am vowing to be more like them--the considerers. More like my mom who let me drive her truck last week so that I could have more space to haul kids. And my sister JoLai who sits on the phone and lets me read her entire essays out loud before sending them in for publication even when she has 250 things to do. More like my friend Jill who went and took Zachary a lunch to school when I had forgotten even though she had the morning off and had a ton of work to do. More like my three colleagues who, without even flinching, actually registered my concern into their own lives and schedules to see how they just might be able to really-not-just-theoretically assist. And lastly, like Deanna--who never, ever missed a chance to see what she could do to lighten another person's load. And more authentic in my assessments of what is feasible and what isn't. . . along with an appropriate willingness to be willing to change things around to help.

Yeah, man.

You know? I guess if Miss Barbra Streisand is right and people who need people are the actually the luckiest people in the world? Maaaan, that means I'm super lucky. Super, duper lucky. 'Cause damn, I need people. I truly, truly need people.

Oh yeah--just in case you were wondering what happened with the second year resident and that ward month? After speaking with his wife on the phone, he realized that he had a family conflict that would make a ward month really challenging for him to take on. But it all worked out because a few moments later, another considerer came along who could.

Yeah.

***
Happy Tuesday. And shout out to all the sho nuff considerers out there.


Now playing on my mental iPod. Sing, Miss Barbra. You better SING that song, chile!





Thursday, January 15, 2015

The mother continuum.



I thought my heart would explode the first time I heard it: "Ma-ma." No, it wasn't the undifferentiated, monosyllabic babbling that happens when babies first discover their voices. This was the one accompanied by chubby little splayed hands, a toothless grin, and that word offered just for me: "Ma-ma."

The novelty wears off after a bit and you get used to it. Waking up in a dark crib: "Ma-ma!" Falling down while first learning to run: "Ma-ma!" And, of course, the first time an older sibling punches or hurts them: "Ma-ma!" Sometimes you cringe, but most of the time it reminds you that you are somebody's mother.

Yes, you.

Then some time goes by. For my kids, it shifted around the preschool age to "Mom-MY" from "Ma-ma." Requests were preceded by "Mommy" and so were those "I'm sorrys" that came after those things they knew they had no business doing.

Yup.

That shift--that is, the mama-to-mommy shift, I didn't notice so much. Like, it sort of slipped in like a thief in the night and didn't create much of a ruckus when it did. And really, it was fine because "mommy" still sounds infantile enough to remind you that they're still you're babies.

But then comes the day that you pull through the carpool lane at school and just before the door opens for them to jump out, they say it. This new thing that you hadn't been hearing before. "Mom."

And maybe other mothers didn't notice it like I did when it happened, but my guess is that some did. A little tiny piece of my heart broke when I did, too. Like "mom" seemed like something for kids with drivers' licenses and cell phones. Not a word that should be coming from the mouths of my little babies.

So yeah. For the last few years, I've been "mom" and, for the most part, it's been cool. But every now and then, I have a day like I did yesterday where things are a little different. Yep.

Usually, it happens when someone has had a nightmare or something. In they run to my side of the bed, cuddling my neck and asking with wide saucer eyes, "Mama? Can I get in bed with you?" Which, in my house, isn't often but does still happen from time to time. But yesterday, it wasn't that. No, it wasn't.

It all started with a text from my own mother. It simply said, "I need you," and nothing more. When I called her, I immediately knew what was wrong. She was having a bad Deanna-day and was missing her big girl something ferocious. I could hear her panting and knew that she was crying the ugliest of cries. And I just held the phone, I did, and told my mama that it would be okay. And, I swear to you, I called her just that. "Mama."

Because, to me, there is a tenderness and innocence in that word. It is primal, like the love you feel for her when you can't even form memories or words. So it seems to come out as that during those times, whether I'm thinking of it or not.

"Mama."

And, sure, before someone goes into a diatribe about how they are from a part of the country where mothers are mamas forever, please, just follow my point and what it means in the evolution of the relationship between mother and child. Yeah.

Okay, so I talk to my mama and it makes me cry. And I was sitting right at the kitchen table where Isaiah was doing his homework when that happened. My sweet boy looked terrified and asked, "What's wrong? What happened?" And I told him nothing had happened. But then he went on to ask, "Please tell me no one died. Oh no, did someone die?" And quickly I reassured him that, no, no one had died recently but that Grandma Shug was just having a day where her heart felt sad about Auntie going to heaven. Before he could say more, I went to the back to speak with her more and held the phone a little bit longer while Will and Fran came to be with her.

And, no, my mother isn't falling a part at the seams or paralyzed by grief but she is human. And humans who've gone through the worst day of their entire life are allowed to have days like the one she was having. Yes, they are.

So, yeah. I get off the phone and return to the kitchen table. I'd cleaned off my face and wiped my eyes with a cool towel. Isaiah was doing his homework and Zachary was on the couch reading a book.

"Mama?  Do you need a hug?" Isaiah asked. And I nodded and told him yes. So he came and hugged me tight which made me shed a few tears again. A few minutes later, Zack came over and scooted onto my lap like he did when he was three years old. He nestled his face into my neck and simply said, "I love you, Mama. Okay?" And I replied to him that I knew because I do.

Around four this morning, Isaiah climbed into my bed "just to snuggle." He quietly slipped beside me and wrapped his arms around me. I was groggy but not so groggy that I didn't catch the first thing he said before we both fell back asleep: "I love you, Mama." My boy was seeing about his mama. Who was sad because she'd been seeing about her own mama. So yeah. He was, even at four in the morning, he was. And damn, I appreciated that. I did and I do.

Yep.

By 7AM, I was back to being "mom" again. And that was fine with me. It was. I called my own mother up who also sounded much better. Her heart was in a better place and the love provided to her by her son and her daughter-in-law had lightened her soul. So yeah. By sunrise, she, too, was "mom" again, and that seemed okay with her as well.

Yeah.

I guess I'm just reflecting on the reciprocity of tenderness that motherhood--and parenthood--afford us. From reaching toddler hands to pat-a-cake to manicures together. And from "mama" to "mommy" to "mom" and back again. . . . it is all a beautiful continuum that only deepens regardless of what you call it. Whether your mother was smooth at it or lumpy at it, I love knowing that some innate piece of us yearns to love her back and shield her heart. Always, always, always.

Yeah.

***
Happy Thursday.

Now playing on my mental iPod. . . .