Monday, April 18, 2016

The finish line.

I took this photograph of myself at a red light. I was driving to the funeral of a woman I've known for over twenty years; the mother of my sorority sister and good friend, Ebony M.


It wasn't sudden. Mrs. M had been fighting a nasty malignancy for quite some time. That said, it's not even being cliché to say that she handled it like a true gladiator. Brave and tenacious, yet somehow never lost the tenderness that made her so special.


Since Ebony is from Birmingham like my dad and, like my parents, hers also attended our alma mater, I was immediately taken in like family by her mom and dad. They treated me like a bonus daughter and never missed a chance to let me know they were proud of anything I accomplished. Especially Mrs. M. She had this special way of showing a person how proud she was of them. I was lucky to be one of the recipients of that gift.


So here's the thing: Even though I'm a doctor, the mortality of those around me--particularly the ones of the generation ahead of me--is something I struggle to get my head around. But the older we get, the more these types of phone calls come. They used to be freakish and far-fetched. Not any more.

At 45, most of our parents now have government subsidized health care and AARP cards. Some have body parts that have been replaced or bypassed or even removed altogether. Feet are moving a little more slowly and, in some instances, so are minds. But the other part is that we, too, are sliding closer into the realm of "people old enough to have stuff happen to them." Which, to me, is this point where, instead of people saying, "Oh shit! How crazy is that?" they instead just tell you how very sorry they are to hear of whatever it is they just heard. Kind of like this threshold where you are entitled to have something messed up happen to you.


And this? This is the only part of the 40-and-up frontier that I don't like so much. Like, I always said to people that your teen years are weird, your twenties are great but you're just too damn broke to enjoy them, your thirties are pretty cool since you're still young and a little less broke, and the forties seem to be where the party is happening. And you know? I would say that the fifties will trump the forties except for this aforementioned thing that throws a wet blanket over a part of it.


Wouldn't it be awesome if parents just sort of halted in their late forties and early fifties for you to join them? Like, where you could just hang out and talk shit with all of your collective wisdom and send kids in the kitchen to get you a glass of ice water and then talk all about the really cool vacation you just took that ten years ago you would have just admired on line due to broke-ness? How cool would that be?

Proud to be my sister's keeper: Ebony and me

But the clock ticks. It ticks hard as hell, man. And on Friday, it screamed loudly in my ear that beautiful, loving, amazing people do not live forever. That long time loves may have to part involuntarily and that a new normal at some point awaits us all.

Damn. I'm sorry. I don't mean to be negative. I don't because that's not how I feel. I mostly just feel sort of reflective and aware, you know? And the look on my face in that picture tells how I was feeling. Which wasn't negative. Just sort of. . . mortal, you know?

Yeah. That.

Mrs. M had the most uplifting homegoing service I've ever attended. Tambourines were shaking and voices were singing jubilant songs. She'd been a part of her church choir and every single member showed up. The soprano section sang with extra vigor since that was her section and, for once, overshadowed the low, dusky melodies of the altos. A dance troupe clad in white gowns with angel wings affixed to their backs celebrated her heavenly transition through movement. And all of it was elegant and the most amazing tribute ever.

Sorority sisters from Tuskegee standing in support of Ebony M.

It hurt my heart to see my dear friend and her sister clinging to one another and weeping. But that, I expected. It really wasn't until I was listening to the choir singing this amazingly thoughtful medley of her favorite hymns that I came unglued. Mr. M, her husband of 45 years, was doing that thing that church folks (at least the ones who look like me) do when the music is so good that it makes your bones rattle inside. He stood to his feet, arms folded and head shaking from side to side. Face twisted into an emotional grimace--partly the familiar one of people in the praise and worship zone but, in this case, partly just unspeakable grief. This man was calling on his God quietly. But especially? He was missing his wife in the most intense way ever.

And that? That did it. That's when I lost it.

I can't say her death was timely. She was too young for this. She was. And that man that stood on his feet in that church still had a lot more years of love in his heart to share with her. This I could see for sure. But. We are all mere mortals. No matter how much we try to think otherwise, we are.

The exuberant preacher at her service said this:

"From the day we are born, we are in a race to the finish line of death. We don't want to run there too fast, but we all cross that tape whether we want to or not."

And I took out my phone and jotted that down because I knew I'd want to read those words again.


You know? That preacher man was right. Even if that sounds slightly macabre, it's the honest to goodness truth. And so. I guess the goal is to run the best race you can, you know? Get your form right and do your best to clear some hurdles. Pass the baton often and run hard at certain times but definitely slow down sometimes for breaks. Hit some high notes like Mrs. M and love somebody so hard that the thought of you causes them to stand to their feet, fold their arms and shake their head. And do so much cool stuff while you're at it that the people who thought they knew you later realize that they had no idea what kind of bad ass things you were doing on your race. None at all.

Growing older is dichotomously awesome and awful at times. But that's cool. My goal is to just to make my run the best one ever, to encourage the runners beside me, and to pause at the water stations whenever I can. And ultimately to cross my finish line without regrets.

That's what Mrs. M did. I'm glad I got to run beside her for part of her race. Because what I now know is that it was a part of my race, too.


Happy Early Monday.

Saturday, April 2, 2016

The dog in the fight.

I came on as the attending on a Monday. An unexpected scheduling need had shifted my assignment from the outpatient clinic to the inpatient hospital service. By the time I joined the team, the month was nearly over and plans were mostly gelled. Consultants were following and things were rolling along as they often do. And during this week, the census was full and the patients were sick. Very sick.

Okay, so I come onto the scene as the Monday morning quarterback--literally. A new set of eyes who is looking at every case from the 30,000 foot view--first seeing the big picture and then trying to serially zoom in on the little picture parts. And this, this approach when I come into something where the ball is already in motion, is generally my approach. I observe and ask some questions. I make up my mind to be a skeptic and to not just go with what's already happening. Even though, most of the time, I am completely in agreement with the current plan.


But sometimes when stepping in something happens. You realize that everyone involved has been so zoomed in that they've lost sight of that big picture. So you come strolling up and start firing off all your queries. They seem like obvious questions, actually. I know this because I've been there. The one who has been slugging it out for weeks on a sick patient only to have someone ask one or two things that make me wonder what the hell I've been doing all this time. That, or they point some very clear observation out that makes you inwardly cringe because it's the kind of thing you should have asked yourself a full week before.

Anyways. On Monday, that's where I was. And there was this one patient in particular that didn't seem to make perfect sense to me. I mean, it wasn't because the last attending wasn't awesome. It was more one of those things where the Monday morning quarterback had the advantage, you know?

So yeah. I look and I ask and I probe. And finally I resolve that we needed to shake up the game plan some. And by shake it up, I mostly meant that we needed to go harder as advocates. 

Yes, that. Advocates.

So what does that mean? Well. To me, it's simple. What I do is close my eyes and picture myself as the very concerned mama-sister-wife-daughter-granddaughter-partner at the bedside. I push myself to let the patient matter to me as it would to that person. I pop in my mouth piece and shadow box in the corner. And then I go as hard as I can. . . as if that person's loved one is strapped on my back pleading with me to help.

Does that sound crazy? I know it probably does.

Okay, so let me explain what was going on without giving too much detail. Essentially, a lot of doctors were seeing this patient and weren't in full agreement. One said to do one thing which would require another one to do a procedure. But the procedure-doing doctor didn't feel so much like that was needed. Then, another consultant was somewhere in the middle. Maybe a procedure, maybe just more antibiotics. But see, for me? The main thing I saw was a patient who, despite all that, was still sick as stink. Which meant somebody somewhere was going to have to do something different than what we'd been doing.


And so. I strapped them to my back. The patient and the ones who love my patient the most. I fought with the zeal of a mama bear protecting her cubs. Called and spoke to attendings directly and asked some uncomfortable questions. Pushed my colleagues to be decisive and to also feel the sweet burden of caring like it is their loved one, too. And what I've found is that I work with some good, good people. These good, good people are very busy and often spread thin. But since they are good, good they are usually willing to slow down long enough to stick a foot in the way of the clinical inertia ball.

We all talked. And thought. Together. Someone pulled papers from the literature and others modified recommendations. The senior radiologists did more than just read the images; they REread them with their experience in mind and the clinical context considered. And all of it felt right and good.

So what happened? Well. Slowly but surely, the patient started improving. But mostly, it felt more like we were on the same team, you know? Instead of just a bunch of stakeholders with our own prideful opinions, we were one big, bad team. Fighting the hell out of that disease and telling it that we weren't the ones to be effed with.  Knowing that not only do we have a dog in the fight, we ARE the dog in the fight.

Yes. That.

And you know? It's not guaranteed that any of this will work. The patient could remain ill regardless of our earnest attempts and reroutes. But I like to remember one of Harry's quotes about losing a fight:

"I might not have won, but he knew I was there and I'm pretty sure he'd never want to fight me again."


Let me be clear: I am just as guilty as anyone else when it comes to all of this. I fall in love with a diagnosis or plan of care that I developed and can't see the forest for the trees. I also forget that my fifteen years at Grady has afforded me a voice that someone might listen to and entertain if I ask questions. I'm guilty of sometimes letting my exhaustion dampen my enthusiasm. Totally.

But then, like clockwork, in comes a Monday morning quarterback. A good, good colleague nudges me to do the right thing. To reexamine things with fresh eyes and to fight like my loved one depends upon it.

Does any of this even make sense? Probably not.

My point is this: There is a lot of stuff that just can't be learned in books. And this? This little shift in how we see ourselves as patient advocates is just one of them. I'm still learning. But one thing I can say for sure is this: I'm still trying, too.


Happy Saturday.