Sunday, September 18, 2016

Being bothered.

There is this lady. This lady that I see every day at a point in my day. Pretty much at the same time. Like, if I walk the direction I need to walk to get where I need to get, I will see her. See her in the path of where I am going. That is, if I take the way that is fastest to get where I need to go. Which is mostly what I do.


So every day, there she is. Doing what she does while I go where I go. But then, whenever I get closer she eases in my direction. Comes nearby and says a cheerful hello, like always. Includes some open ended questions that call for me to open it into a conversation. And then, if I don't run any form of interference, she will pause to chat. A little bit about this. A little bit about that. And a little bit about the other, too.


All of it takes no more than 2 minutes, really. And sometimes less than that if all she wants his a hello and a hug. She is a hugger. One who puts her whole body into those hugs, too. Both arms, torso to torso, and pressing into you. Complete with the "mmmmm-mmmm!" sound effects. Yes, she does that.

She does.

But. There are some days. Like, some days where I feel like I'm super busy and feeling harried. Or where I'm late.  Like, where I really just want to get to where I am trying to get without stopping to chit or chat or hey or hug. Even for a moment. Telling myself that I am just "focused" today and want to just stay on my task. Whatever that task may be.

And so. On those days, my walk is more brisk. My body language is fast and deliberately standoffish. I typed and deleted that last sentence twice. That word "standoffish" made me cringe. Especially when connected to me. I had to add it back because it is true of what happens. That is what I do. Like,  on those days, I do this thing to demonstrate that I don't want to be interrupted. Not even for a hug.


So on those days, she will call to me in her singsongy voice as I whisk past going wherever I need to go. She simply calls out a "hello" that floats out into the vacuous hallway then swirls down to the ground like some kind of lonely feather. My salutation in return shoots out and hits it like a fast ball. Quick, pressured. Making it clear that it would be this one pitch. And that's it.


Doing that always feels bad. I mean, because it's not nice really. I'm old enough to know that. So on a lot of days, I just take this really circuitous route to the place I need to go that doesn't take me past the place where I would pass her. But fickle fate somehow always reroutes her path to overlie my own at some point. It does. So then, I'm back to where I was. Either cooling my jets or deciding to turn them on high.


I am not proud of this. I'm writing about this because I am just thinking this morning. I'm thinking about those two minutes (or less) that I so stingily clasp in my hand. My decision to withhold some piece of me, albeit a fleeting piece, because I just sort of don't feel like being bothered. And you know? I am really not sure why I don't want to be bothered by this very sweet individual on some days.

There is this melancholia about her. Like this piece of her that I can tell needs a human interaction as much as she can get it. And I think it's even worse that I am not always forthcoming with it since I know that. Like some sort of middle school mean girl who has decided not to be your friend. On certain days.

Maybe the sadness in her eyes overwhelms me. Makes me feel like what I give needs to be all or none. And like the all isn't necessarily my job since I work a job where I have to give that kind of all all the time.

I don't know.

I know about pieces of her world. Even though I don't have a lot of contact with her, there is the stuff she has told me. And, no, I don't know what her full world is like away from the place where I pass her each day. But what I am processing this morning is this realization that I am a tiny sliver of her world.

I am.

There's probably some complicated piece of my psyche that this underscores. And I don't know what that is since I'm not a psychiatrist. But what I do know is that I love people. And I want to be a good person.

So today, I've made up my mind. To be bothered. And interrupted. By her.

And before you say that, from what you read on this here blog, I seem very good about being bothered, I will say that on some accounts I am. Like, I am very, very good about say, a stranger, in the Grady hallway hitting my pause button because they are lost. Or that wayward medical student who wants to pick my brain. But this? This is different. This interruption is like that movie Groundhog Day. I know what's going to happen. Yet I find myself using some energy to redefine the outcome and order of events.

I'm not really even sure why.

Withholding kindness isn't cool. Even if on other days you give an extra heaping helping of it, it's not.  And so. I am going to work on that. With her. With me. Because two minutes is nothing. Except for when it's something.


Happy Sunday

Sunday, September 11, 2016

Love is the what.

"Any man's death diminishes me, because I am involved in mankind; and therefore never send to know for whom the bell tolls; it tolls for thee.” ~ John Donne

It has now happened to me too many times to count. A person comes into the hospital. Our hands touch at that first meeting and our hearts connect. No, not just in some obligatory way that gets outlined in that first year med school lecture about "BEING EMPATHIC." But more in a natural way. The kind that happens when you strip down the armor of stoicism and reveal a piece of who you truly are. 

Yes. So this happened to me this week. It did.

From our first encounter, I knew. I knew this patient, this person would leave me forever changed. I inwardly chuckled, knowing that it would be one of those weeks of late departures--not because of neediness on her part but my own selfish desire for more. More while I could have it. More because my patient was preparing to leave. She was.

It wasn't obvious at first. So mostly, it was just her quick wit and wisdom that created this giant magnet to which I attracted. Between laughs and reflections, I'd coordinate her care with the residents and speak to consult teams. And for every single day that she was there, I would round on her twice. First, for logistical things like pain control and management. Then, to simply close out my day. I'd drag a chair to her right side, hold her hand, and soak it in. I would and I did. 

On Friday she was slowing down. Together we'd agreed upon a master plan for an intervention the following week aimed at making her feel better. But some piece of me was conflicted. "Is this what you want?" I asked her. 

"What do you think?" she said.

"I think I don't want you to be uncomfortable."

"Okay. Let's play it by ear, okay? If I'm not up to it, I think you will know. And I will trust your judgement."

"I will pay attention, okay?"

"You always do, Dr. Manning." 

And that was the end of that discussion.

When I stepped into her room yesterday, the lights were off. It wasn't pitch dark, but more filled with shadows and only the morning sunlight. The family was at the bedside and another consultant was there, too. My team walked in and the family, with whom I'd also developed a connection, notified us that she wasn't talking. The pain in their faces grabbed me by the neck and punched me in the chest. And that, coupled with those shadows, was telling. It was.

I went to her. Usually, I offer a subtle hello and fall back when a consulting colleague has come first, but on this day I broke the rules. She was my patient. An urgency was swelling inside of me. Something was telling me, screaming to me--"You will not get a 'two-a-day' today. You will not." 

She was looking straight ahead, not speaking but appeared totally lucid. Like all of this silence was voluntary, representative of elevated thoughts and reflections. The first thing I did was touch her hand like always and move close to her face. "Hello sunshine," I murmured. 

And just like that, her face erupted into an enormous smile. Relief washed over the family and even the consultant. She was still there. She was. But still. I could feel it. Her hand on this day was ice cold. Yes, her spirit was still warm, but nothing else. 


I asked her questions about her pain and nausea. She nodded yes and no appropriately and told me how she was. All nonverbal but still fully present. And so. I kept talking to her. And to the family. Fielding questions from them and all the while holding her cold, cold hand. 

The consultant slipped out and all that remained was the family, my team, my patient and those shadows. More questions from the family came. Concrete queries that you ask when you love somebody. Love's myopic view doesn't allow for big picture objectivity. Not that kind of love. But what I've learned is that some piece of this love category, that is, the doctor-patient love category, leaves the sliver of insight that gets lost in other kinds of love. And now that I know this, I have to use it. I must.

So, I try. I try to talk but my face. It starts to get boiling hot and those tears. Those pesky tears they pour from my eyes. My voice cracks and I feel her icy hand tighten around mine like a vice grip. She knows. Her clasp stabilizes me. She gives me courage to be honest and transparent. And so I do.

I give her hand an affirming squeeze to let her know I got the marching orders. Then I turn to her daughter. "Tell the family to get here. Get them here. Today. Now. To love on her. Love hard on her like she loved on all of you." And then I started weeping outright. And because she was holding my hand, I couldn't even wipe the tears fast enough since that would have been a two-hand job. 

"Love on her," her daughter repeated while holding my gaze. "Love on her." 

"Yes. It's all we have. Love is the what." 

There wasn't much more to say after that. Our rapport was good and my patient's response was obvious. I leaned in to tell her good bye and asked once more if she needed anything. She nodded yes to pain medicine and no to nausea medicine. "Okay," I told her. "I got you."

And then, just like that, she spoke. "You look so beautiful." Her voice was clear. Nothing garbled or suggesting confusion. Sure, direct, clear. And those words? They were a gift. Not just to me, but to her family. They needed to know that she was there. 

Shortly after that, my team left. Sujin, the third year medical student broke down crying and I consoled her in the hall. And my intern Sonali did the same. "Let it hurt. You want to be affected," I told them. "And don't let anyone tell you otherwise." Then, all of us just stood there in quiet awe of the amazing privilege we'd been given as the caregivers to this soul. We sure did.

A nurse saw us walking up the hall afterward. She asked me, "What happened? Did your patient expire?"

I smiled with my red face and snot-filled nose and replied. "No. We are just feeling fortunate to be her doctors. That's what you see." That is exactly what I said. Because it was true. 

My patient passed away yesterday. Only a few hours after that encounter. That family got to her and they were all glad they did. Sonali, the intern caring for her, loved her, too, so returned to the hospital. That sweet intern sure did. And all of it was good. It was. 

I'm so glad my boundary issues allow me to feel this way. My chest is heaving as I write this, but in the very best way. We are all connected, I think. Being aware of it and surrendering to it is the issue. That's what I think.


During one of our late afternoon handholding sessions, my patient asked me to write about her when she transitioned. I promised her I would. And so today, I honor that promise and also present a piece of her love to you. Because love? Love doesn't expire. And love, my friends, is the what.

Happy Sunday. And thank you for Angella for that beautiful mantra that I say or write somewhere nearly every day.

Sunday, September 4, 2016

Rose-colored heart.

My patient took off her glasses and said, "I can't keep looking through these rose-colored glasses. I just can't."

I was holding her hand and both of us had tears in our eyes. Her body was sick and she knew it. I felt sad because there wasn't any other treatment to offer.

Then, all of a sudden, she looked at me and smirked. "You know what? I just noticed that these ol' glasses of mine really are rose-colored!" She threw her head back and laughed so hard that I did, too.

After that, we just sat in silence. Holding hands, looking out the window, and wishing on invisible stars.

Happy Sunday.

Thursday, September 1, 2016

Words of affirmation.

Today I received an email from a former Emory student/resident that was, quite possibly, the single, most moving thing I've ever had written to me or about me in my entire career. I'm busy right now. Just got back on the hospital service. Have been mad at myself about missing personal deadlines on completing a manuscript I need to finish. And dreading the over 15 "strong" letters of recommendation that students are depending upon me to write for their residency applications. This work can be so grueling sometimes. And sometimes thankless, too.

I started out this day feeling frazzled. I rushed the kids all around the house this morning and still got both of them to school just after the bell. (Fail.) After that, I drove to work coaching myself like a good girlfriend, saying things like, "Girl, stop tripping! You are a great mom" and "Oh, come on. You're an awesome doctor." Because, you know? It was just one of those days. I was so turned around at one point that I thought it was Friday. Except it was Thursday.

But then I checked my email. While sitting in my minivan waiting for my son to come out of ultimate frisbee practice and feeling flustered about the things I still had to do once I got home. A simple tap of my thumb and there it was. Waiting on my iPhone like a balm for my soul. On a day that I truly needed it.

As a clinician educator, I have won some really great awards--I'm talking career-defining ones that parents and family fly in to witness. I've also done some cool stuff--from talking to Anderson Cooper on CNN to publishing in JAMA and Annals of Internal Medicine in the same month to even getting a medical blog nod in the doggone Oprah Magazine. But nothing--and I do mean nothing--compares to one individual learner's affirmation that you've had a real, true impact on his or her life and career. It supersedes any trophy, plaque or media attention. My fellow clinician educators (and educators in general) know what I mean.

You know what? I feel like going on.


Happy Thursday (not Friday.)