Wednesday, July 6, 2016

You are invited.

#‎altonsterling‬ ‪
#‎trayvonmartin‬ ‪
‪#‎michaelbrown‬ ‪

Like many of you, my social media timelines have been flooded with frustrated, hurt, angry posts in reaction to the senseless death of yet another black man at the hands of police. This time, it was Mr. Alton Sterling of Baton Rouge, Louisiana. It was captured on a grainy cell phone camera. Two cops took him down and shot him multiple times at close range ending his life. His kids saw that video. I saw it, too.

Here's what I'm thinking about:

Just maybe, you are my friend and your world hasn't been flooded at all with bitter one liners and battle cries from your peers about this. Just maybe, you have checked your social media threads of choice several times but, because this doesn't hit quite as close to home for you or those whose posts fill your screen, you had no idea about this incident until just now. If that is the case, consider this an invitation. First, to Google #altonsterling to understand what happened (if you weren't aware already.) Then, I invite you--my nonblack friend---to be as sickened, appalled and bothered by those hashtags as me.

That is, if you weren't already.

I want you to imagine talking to your sons about police and feeling your heart turn a tiny relieved flip when your husband comes home from a regular day--alive. Talk to your kids, make this a big deal in your house, and please, join us in being pissed off--because everything depends upon that. Nothing changes when we don't provide anybody space to empathize. But now that you have the space to stand with me, I want you to know that any indifference here forward will be hurtful--whether I am telling you or not.

I think we are all super guilty of polarizing others when upset about the things that affect our own communities. Our soapboxes are so tall that they make people shrink, hide and peep through their blinds like voyeurs. Black, white, straight, gay--we build these walls that won't let good people be allies--or at least let them ask enough questions to feel something. And no, I don't think it's intentional. Pain just makes us all impulsive.

At least that's what I think.

For my friends who don't know what it's like to worry in this way about your father, your brother, your husband and your sons. . .I want you to read this post (if you haven't already.) If you feel so inclined, you can also read or re-read this one, too. It will give you more perspective of what it's like raising black boys in America.


Then my hope is that you will accept my invitation. To ask questions. To comment. To say something. To feel something. But especially to be pissed the eff off. Because no movement ever really gets moving until more than just the oppressed get mad. My prayer is that we can all be a little more aware of each other's joy, pain, sunshine and rain.

This is our reality. Thank your God if it isn't yours.

Happy Humpday.

Sunday, July 3, 2016


my situation on June 23, 2016. Literally.

  1. danger of loss, harm, or failure.

Two weeks ago, I did something that I have never done in my entire medical career. Had I come close to it before? Yes. And is it something I probably should have done a few times in the past? Definitely.

So . . .  what was it that happened, you ask? Well, I'll tell you. Um, yeah. . . I'll tell you even though, after twenty full years of not doing this, it's pretty hard to actually confess. I. . I. . .sigh. Okay. . .I. . .I . . . I .  . whew.

I. Called. In. Sick.

*squeezes eyes closed and turns head so you won't look at me*


It was the week of our interns' orientation in the hospital. Those first few days had gone just fine and at the end of the hustle-bustle of a particularly crazy afternoon, I popped by a casual eatery to grab a late lunch. And that part was fine, too.


It wasn't until about an hour and a half later that I began feeling this cramping sensation in my midsection. My tumbly became rumbly and before I knew it, I was in and out of the restroom doing what the Grady elders (and my daddy) refer to as "running off." Somehow I managed to get a long enough window to get over to get the kids from their camps but admit that I sprinted from my car to the front door.

Thank goodness I did.

And you know? The running off part I could mostly deal with. I mean, I was hydrating and such and told myself that if there wasn't anything in my gut, the "running off" would eventually "run out." But then came the nausea. And then came the vomiting.


And so. I pretty much spent the next several hours trying to decide which end of my body to aim at the commode. I tried all those home remedies like ginger ale and the non-home remedies, too, like antiemetics and antidiarrheals. But mostly, this was something that was just going to have to run it's course. Literally.

I didn't catch a wink of sleep until about 4:30 that next morning. My alarm went off at 6am and I just sort of stared at it for a few beats before silencing it. Finally, I sat up on the end of the bed and prepared to treat the day like any other Thursday. I grabbed a t-shirt and a pair of sweats, pulled on some socks and shoes and prepared to walk Willow. And that was fine, too.

Well, I take that back. It actually would have been fine if I wasn't lightheaded from my certain dehydration and on the verge of vomiting the remains of the Canada Dry ginger ale and the electrolyte drink that I'd carefully sipped all night. After only two steps toward the door, I felt my belly churning again. But still, I grabbed the leash (and my tummy at the same time) and took Willow for what I am sure was the least gratifying dog walk ever.

You know? I didn't even think to wake Harry and ask him to take the dog out instead. Even though I knew he would have, I didn't. Then, when I came back inside, I stood staring at the medicine cabinet and trying to decide which concoction would allow me the best chance at not barfing all over a patient. Or passing out on them.


But somewhere in the middle of all of that, I spoke out loud even though no one but me was awake. "I  really, really feel like shit." Which, I am sure, is exactly what I said. Followed by a dry heave.

And right then and there, I had an ah hah moment. I recalled all of the times I've told countless residents that self care is essential. Even though, particularly when it has come to personal illness, I've never given my health priority over going to work.


It dawned on me that if I were advising any of my students or residents, I would tell them to immediately contact a supervisor in order to afford that supervisor as much time as possible to cover the clinical duties. And then I'd tell them to drink, drink, drink fluids like crazy and get in bed under the covers and get some legit rest. And/or seek medical attention if it is even more serious.

But for myself? Chile please.

So with my dog at my feet wagging his tail and me hunched over the kitchen sink on one elbow out of fear of projectile vomit, I made up my mind to do the unthinkable. Yes. I decided to call in sick.

Um, because I was. Sick, that is.

Now. I tried as hard as I could to recall a time ever in my career that I'd done that but came up with nothing. And I think I came up with nothing because that adequately represents how many times I've decided to stay in my household infirmary versus crappily do my job while ill. And how many times I acknowledged that I was too unwell to work.

I blame jeopardy. Confused? Okay. Let me explain.

At nearly every residency training program, there is this back up schedule that is designed precisely for moments such as these. And you know? Nearly every residency training program calls it by the same name: JEOPARDY.


So when one is sick, they call the chief resident or schedulers or whomever--and that individual refers to the "jeopardy schedule" and notifies some unlucky soul who, up until that moment, was basking in an awesomely easy assignment. Only to be thrust into the firing line of some essential patient care situation such as the intensive care unit, hospital service, or something else even more hellacious. And yeah, it's exactly as sucky as it sounds when you get called.


Similar to, say, jury duty, everyone knows that the jeopardy schedule is everybody's necessary civic duty. That is, in the resident community. But, just like jury duty, it isn't one of those things anybody is particularly pumped up about getting notified about. But physician jeopardy is more complicated than that.


When I was a resident, we had this longstanding culture of bravado when it came to toughing it out through illness on the job. And I can't say that it was because our program leadership wasn't supportive of our personal needs. It was just this thing that sort of happened, you know? Most of the time they had no idea.


Well, I take that back. They were supportive when a person actually endorsed being ill as a reason to call off. But because they came up in the same system, I can't ever remember anyone insisting that someone leave back then. Go lie down for a few moments? Sure. But full on leave and cause another resident to be called in? Never.

Oh, and before I go further, I will say that there is always this teeny, tiny subset of individuals that call jeopardy 200% more than anyone else in their entire program. Most notable was this girl who had taken two benadryl on accident and called in because she was afraid she'd be drowsy. (Me countering her with the half life of benadryl, which she'd consumed 4 hours before, didn't seem to make a difference.)

Anyways. The vast majority of my resident colleagues worked when ill. Furthermore, there was this esprit de corps between us that caused us to rally around the sick guy and fill in the gaps. (Forget the fact that everyone was getting exposed to whatever illness the person had.)

Uhhh, yeah.

A few times stand out in particular. One was my junior year when I was taking call in the cardiac care unit (CCU.) I came down with fever, chills and a terrible headache. My neck was tight and I had some nausea and diarrhea, too. It was the summer and I had just come off of the pediatric inpatient service where kids with aseptic meningitis from enteroviruses was rampant. I even had a tell-tale viral exanthem (rash) to go with my constellation of symptoms. And you know? I was 99.9% sure that viral meningitis was exactly what was going on with me.

Maybe even surer than that.

I called one of my classmates (who was also on call) and asked him to come examine me in the nurses station which he did. "Dude. You probably got viral meninge. You gonna go to the ER and let a second month intern do a spinal tap on you?" He bit into the room temperature honey bun he was eating and laughed at his own joke.

"No way, dude. Did you see my rash?" I asked while pulling up my sleeve.

"Cool," he replied. "So what are you gonna do?"

"I think if I take some Motrin, I can make it through the night."

"Yeah, probably so."

And I am not kidding you. This is what happened. I took the call, fever, stiff neck and all.

Super stupid. Especially since it could have been something far more serious.

That same friend called me the following year (when we were both on call again) to check him out in a call room. He'd developed some shaking chills and a nasty, rattly cough rather suddenly. When I got there, he was breathing super fast. "Dude! Holy shit. You look like you're about to code."

"I feel like I'm about to code."

I listened to his lungs. "Yikes. You've got signs of consolidation. This looks like a bad pneumonia. And that history, man! You might have pneumococcus, I think."

"Hmmm. Cool. Think I can tough it out?"

"You're breathing pretty fast, bud. Let's go to the PICU nurses station and pop a pulse oximiter on you to see if you're hypoxic." Which is exactly what we did.

Guess what his oxygen saturation was? 82% (96-100% is normal.) Craziness.

Let me tell you. This guy? He looked sick-sick. It was NOT a soft call. At all. That said, I am convinced that were it not for the whole needing oxygen thing, he would have slugged it out through that call with his pneumonia.


Would you believe that he got admitted to the hospital that very night? And you know? We were so entrenched in that culture that I can remember like yesterday cracking jokes in his room about him spreading TB to the interns and telling him that I was totally going to present him in morning report the next day.

Which he found funny, too. That is, when he wasn't nearly about to code.

Uh, yeah.

I blame this word "jeopardy." The actual definition means "danger of loss, harm or failure." I can't think of anyone who has ever wanted to be the one responsible for putting someone in that situation--that is, one involving jeopardy. Especially another overtired resident who finally, finally, finally is on a lighter work assignment.

But see, that word just underscores the culture. It sounds heinous, punitive even. And to tap into it literally puts another person in peril, if you follow the definition. And I think that's a part of the problem, frankly.

The one time I called jeopardy as a resident was when my father had a massive heart attack requiring emergency surgery. And you know what? I actually took call all night before taking a flight out, now that I think about it. We also have a jeopardy schedule (also called "jeopardy") in my current faculty position and you know what? The one time I called jeopardy with this group then was on November 15, 2012--the night my sister Deanna passed away.


So yeah. I am reflecting on all of this and realizing that doctors who neglect themselves really aren't the best physicians at all.  Coming to work while truly ill puts patients in danger, can make things worse and it probably increases the chance of an error happening.

Now. Do I think folks should be calling off for sniffles or allergies? No. Do I think taking two benadryl should allow a rain delay at best but not a full on call off? Damn right. But do I believe that a vomiting, diarrhea-ing, teeth-chattering person should have another able physician working in their place? Definitely.

If you ask me (though no one did) the first step is changing the name. Instead of calling it "JEOPARDY" it might be better to refer to it as "FAMLY EMERGENCY/ILLNESS PATIENT CARE BACK UP." This way, those who need it will understand when it is to be called. And those who get called will feel okay with being called in.

We could even call it "FEIBU" (pronouced FAY-BOO?) for short. As a reminder that this is for FAMILY EMERGENCIES and ILLNESS when back up is needed. And that FAMILY EMERGENCIES and ILLNESS happen and aren't a sign of weakness at all. 

Mmmm hmmmm.

Oh, and the times that folks get pulled in because of human scheduling glitches NOT due to the needs of a colleague dealing with a FAMILY EMERGENCY or ILLNESS? Well. Keep right on calling those times  "jeopardy."


So yeah. I acknowledged that I was ill and called off the other day. My colleague Stacie S. was great and made sure I didn't have to feel guilty. And my other colleague Alanna S. was super kind about picking up my slack in the resident clinic that morning. And you know? I think if my patients knew of my decision, they would have appreciated my choice to call off, too.

And so. I drank fluids and rested in my bed all day. That photo is proof that I was exactly where I was supposed to be, too. I went through a whole lot of hand sanitizer and considered going to get a bolus of IV fluids at one point. But the next morning, I felt a thousand percent better which taught me a mighty lesson.

And you know the best part? Not a single patient was harmed or put in jeopardy--thanks to my decision to first put the oxygen on myself.


Happy Sunday.

Now playing on my mental iPod. . . .

Friday, July 1, 2016

Love of my life.

"It's the end of a love affair. But not just any love affair--like the love of my life." 
~ Mr. Caldwell

For as long as he could remember, she was there. From those early days sitting criss-cross applesauce on the porch shelling peas with grandmama, right along with the unmistakeable scent of red Georgia clay was the hint of her presence wafting by with every humid breeze.

"I can't remember a time without that being a part of my life," he said. And when he said it, he looked down at his hands and sighed. "I just can't."

There was a sadness about him. This heavy cloak of melancholy that pushed against the agenda I'd planned before entering the room. See, this was supposed to be a congratulatory conversation. Me applauding his triumphant separation from alcohol.


But as soon as I came into that room and laid eyes on him, I could feel it. Yes, this was a good thing he'd done for his health. And definitely, abstaining from Jack Daniels for 16 full months after nearly a lifetime of being his best friend is no minor feat. So, yeah. I had all these lofty plans of shaking his hand hard and telling him how great it was. Reaching out with both hands and staring deep into his eyes to let him know that I meant it.

Because I did.

But. None of that felt right once I actually sat down. His shoulders were curled inward and his expression was lonely. Like some middle school kid chosen last in the kickball lineup, the kind you immediately want to hug and defend. Yes, Mr. Caldwell had crossed the one year hurdle with AA and had the improvements in his health to show for it. But still. He didn't seem happy.


I guess I'd sized him up with this assumption of what he'd be like and where his mind should be, you know? Imagining some gum chewing chap with a bunch of AA key fobs proudly telling it on the mountain that he's just taking it one day at a time. I was expecting a testimony of how now even the smell of alcohol makes his stomach turn a little, especially now that he's broken free of that stronghold. But that isn't what I found.

At all.

"You seem sad," I finally said. "Like. . . . what you've done for yourself is so amazing. And you're doing so great, too. But you seem. . . . I don't know. . . sad."

Mr. Caldwell just stared at me for few moments without speaking. Then, instead of saying something in response, he just sighed and shrugged. His lips moved and I think he said, "Yeah" -- but it wasn't audible.

"Is everything okay at home? Did something happen?"

"No, ma'am. Everything fine with my people, Miss Manning. My kids so happy I don't drink no more." When he said that, the corner of the left side of his mouth turned up a bit.

"That's great, Mr. Caldwell!" I did my best to ramp up the enthusiasm to counter his somber mood. It didn't work.

"I'm okay," he finally said. Then, to make sure I knew he meant it, he repeated himself, this time a little more firmly. "I'm okay."

I leaned into my palm with my chin and squinted my eyes a bit. "You know? You don't seem so okay, Mr. Caldwell."

And something about that--my body language and that last statement--unlocked something. I could tell. His eyes focused on mine some more and I could tell he was trying to decide whether or not to tell me something.

"Tell me," I pressed. "Tell me what is making you so sad."

Mr. Caldwell took a big drag of air through his nostrils, closed his eyes and then shook his head slowly. Then he just froze for a beat with his eyes still closed before parting his lips respond. "I . . I just. . . " He sighed once more and went on. "I just miss it is all."

"Miss what? You mean drinking, sir?"

"Yeah. Like, I keep waiting for that point where I lose the taste for it but it ain't never happened. So when I see it or smell it or see folks drinking, it . . .it just. . .I guess it just make me feel sad."


"Like. . .  you know how when you was little how your main memories are tied to how stuff smell or the sounds you hear? See, that's how it is with me and drinking. Like, I come from a long family of alcoholics. But not fall down drunk and cuss you out alcoholics. Happy, domino and card playing drinkers. Shit talking and laughing. Having fun. But drinking the whole time. Even with kids around."

The image he'd painted was so vivid that I was at a loss for words. He kept going.

"My grandmama and my granddaddy drank a lot. I was raised around them and both my parents died from problems related to drinking. So I know that it's bad for my health which is what got me to quit, you know? That time they kept me in the hospital, I knew I had to quit so I did. But I guess as time go by I'm realizing that just about every memory I have involve either me drinking or being with somebody who was drinking. Going all the way back."

"You know what, Mr. Caldwell? I never thought of it that way." I said that because it was true. "For you, alcohol is like an old friend."

"Naaah. It's even more than that. Alcohol for me? She family. As much a part of my family as anything. Even when I was a kid."

"You started drinking as a child?"

"Naw, not at all. But my auntie'nem used to sit us on the porch and braid our hair down in cornrows. My mama didn't like cutting out hair so us boys always had braids. I'd be sitting right on the step between her legs. Every so often she'd fuss at me or my cousins saying, 'You bet' not knock over my damn drink!'" That made him laugh. But it was fleeting. "It's funny 'cause whenever I smell some gin, I want to cry for missing my auntie so much. That mixed with Newport menthols. And then along with the smell of some collard greens cooking with ham hocks and the sound of somebody cranking a ice cream maker."

And that? That made my eyes sting. Partly because I finally understood what he meant. But also because I knew there wasn't really anything I could do about it. I started to counter him with some canned commentary on the health benefits of no longer drinking but none of it felt right. Instead I just twisted my mouth and nodded. Because I got it.

I put my hand on his and squeezed it. "Thank you for giving me a new perspective, Mr. Caldwell. I get it."

Finally, he let out an unexpected chuckle. "Sometimes seem like the ones you can't get enough of don't love you back, do they? I love her but she don't love me."

"Yeah, she's funny like that."

"But I miss her. Every single day. Even though I shouldn't, I do. And all the people I loved though the years that's associated with her. My whole world different. My whole life different."

"In a good way?"

"I'm alive, which is good. I ain't getting DUI charges, which is good. But just imagine if whatever it is that connect you to all your favorite people, favorite memories and favorite things, you can't do no more. Or if you couldn't be around none of it no more. It's hard."

"That sounds super hard."

After that we just sat in silence. Him looking directly at me, face washed over with this complicated grief, and me squeezing down on his hand with mine. I kept wanting to say something or feeling like I should but nothing was feeling authentic enough. I stayed quiet.

Finally, Mr. Caldwell sighed and gently pulled his hand back. "I appreciate your concern, Miss Manning. I do." He began sliding his papers and medications back into his little knapsack and then pulled the drawstring closed. Patting the bag, he said for closure, "Yeah. So I guess I'm sad 'cause it's the end of a love affair. But not just any love affair--like the love of my life."

"Wow," I whispered.

"Sound crazy, don't I?"

"No, sir. You sound honest."


In the twenty years that I have been a physician, I have asked the same question of countless patients struggling with alcohol use disorders: "Did you grow up with any drinkers?" To date, I have never once heard a response that included anything other than the affirmative.


This? Mr. Caldwell's story? It opened my eyes. He taught me a new layer of why it's so hard for people to let go of alcohol. And you know what else? Thanks to Mr. Caldwell, I will never look at alcohol abstention the same way again.


Happy Friday.

Now playing on my mental iPod. . . .Mariah Carey singing "Can't Let Go." Because sometimes, even though you try, you can't let go.