Bias landmines.

12: 01 P.M.

My intern was presenting this patient to me at this exact time. My tumbly was feeling pretty damn rumbly and lunch couldn't come soon enough. But we were almost there. Last patient of the morning. Fairly straightforward. Acute decompensated heart failure--one of the most common things we see.

Good.

I have to admit that I was glad it was something "bread and butter" and not something exotic. Nothing about this seemed to be a diagnostic conundrum. And that was a relief considering it had already been a long morning of medical mysteries. On top of that, I was hungry.

Real hungry.

Yup. I'm human so yes, I get hungry. And that can feel more urgent as the noon hour approaches. My mind wanders off for a second and then I mentally smack my own face. Terrible, I know. I shadowbox internally, ignore my growling stomach, and keep listening.

He described a youngish guy admitted for severely elevated blood pressure, heart failure, and fluid on his lungs. "He takes his medications faithfully," my intern said. "And, for the most part, he eats right. Not really sure why this current set back happened."

"Okay," I said. "Where does he get his meds?"

"Grady," he replied quickly. "Right at our pharmacy. And I checked to see if he's filling his meds and he totally is."

"Hmmm. Okay." I thought for a second. "And you said no dietary indiscretions?" My intern shook his head. My belly made another audible protest. "Chest pain?"

"Fleeting chest pain--but his EKG and cardiac enzymes are all normal."

Just then, there was an interruption. A man in a hospital gown shuffled past us, IV tubes dangling from his wrist and forearms. Definitely not much older or younger than me. The ashiness of his skin was amplified against his espresso-colored complexion. He looked over at my intern and smiled revealing the tell-tale dentition of limited resources and a hard life. "Just hitting this commode," he said in our direction.

"We'll be right there," my intern spoke back to the man. "Just telling my team about you."

And the patient nodded and disappeared behind the sliding door to his room.

"Hey--did you check a urine drug screen?"

My intern paused. "I actually didn't, Dr. M. But I did ask him about illicit drug use. He doesn't do any of that."

I nodded and twisted my mouth. "I'd recommend checking anyway."

He looked perplexed. "Check a UDS?"

"Yeah. Cocaine could unify all of this, honestly."

"But. . .he doesn't use cocaine."

"I've been burnt many times."

My intern's face flushed crimson. "Oh. Okay. Sorry about that."

And that was it.

Of course, you know what happened next. I walked in and met this gentleman who told me the exact same story. And the pharmacy record and his appointment history supported what he said. He denied any drug use and, on top of that, had prior screens that all were negative.

Yup.

He just had bad heart failure. Period. And sometimes bad heart failure just misbehaves without much provocation. And yeah--he had eaten a little bit too much salt but that wasn't on purpose. It was because eating fresh, non-processed foods is expensive and hard. But the brother was trying. Damn, he was.

I gritted my teeth and felt my masseter bulging. Between my stomach growling and my intense remorse about the microaggression I'd just committed against my patient, it was hard to think straight.
Hallelujah for bread and butter medical problems.

We gave him IV diuretics to get fluid off. We optimized his blood pressure meds. We restricted his fluids. And we consulted the heart failure team. And that meant rounds were over. The team broke up and that was it. Before I could even think of a way to right my wrong.

Yup.

I walked into our team room a few moments later and was relieved to find everyone there. They were all getting their lunches and preparing for the resident conference. I could already feel my face getting hot.

"Umm. . .guys? Can you give me a minute of your time?" They all sat down and obliged me. Even though I'm certain they were hungry, too. I cleared my throat and spoke. "I was wrong."

Their eyes all widened.

"Ummm. So yeah . . . . when Mr. Mackey walked by I sized him up. I saw a youngish, poor black man walking through Grady. And my bias was at play when I asked for that UDS. I looked at him and considered crack cocaine. I was wrong." My intern was staring intently. "I know if he was a white woman at Emory or even an insured black patient somewhere else, I probably wouldn't have suggested that. Please cancel the urine drug screen if it hasn't been collected yet." I sighed hard and looked at the patient's name on my list. "I'm sorry Mr. Mackey."

No one said anything. So I went on. "Look y'all. I'm a work in progress. I'm still messing it up sometimes, too. But I want to own my biases and do better, y'all."

My team was so gracious. After that, we discussed "bias landmines" such as being hungry, tired, rushed, or stretched too thin. We also talked about owning your biases and trying to do better. It was super powerful.

I cried as soon as they left the room. Not out of shame but more because I honored my patient and believe that I taught my team more about bias through that one moment than any lecture they could ever get.

Yup.

Look, man. I do NOT have all this stuff figured out. Mr. Mackey fell in a group that I believe myself NOT to be biased against. Still, my actions said otherwise. That's what's so troubling about implicit bias. The heart feels one thing but the mind goes rogue.

And so. I call it what it is and vow to keep fighting. Fighting the monsters that hurt my patients and my community--even when that monster is me.

Yeah.

*name and details changed to protect anonymity

Stand by you.

"I'll stand by you." - Chrissy Hynde, The Pretenders

Rounds were over and, mostly, not much more had to be done other than write notes and arrange discharges. She, the resident physician working with me, was still at Grady. I was not.

That morning, things were fine. But then came the call from his nurse. A new complaint--one that hadn't been there before and that wasn't there on morning rounds. My diligent resident quickly went to assess the patient. Vital signs not normal. A heart beating over 120 times per minute, little beads of sweat on the forehead of a person who was cracking jokes just an hour before.

Crap.

"He doesn't look good," she said to me over the phone. "I'm concerned about him."

And the way her voice sounded over the phone, I knew she meant it. Even crackling through my blue tooth car microphone, I could tell. I also knew because I'd been working with her all week and had seen her empathy in high def for nearly seven days already.

"What do you think is going on?" I asked. And, with that, she described everything she'd seen. A head to toe examination, a review of the labs, and a thoughtful differential diagnosis of things it could be.

"Does it sound like I'm missing something?"

"If I were by myself, I'd be thinking the same things," I replied. "I have nothing to add. This plan sounds very good."

"Okay."

"Would you like me to come up there?"

There was a pause. "I don't think so," she finally said. "I feel better since we talked through everything. But thank you for offering, Dr. Manning." And I could tell she meant that.

This woman is a senior resident. And not just that any senior resident. I highly competent, extraordinarily professional, incredibly thoughtful young physician with a knack for caring for the sickest of patients. Honestly? She was all over this. Her fund of knowledge in a lot of areas exceeds my own. In my head, I was saying these words: "You've got this." Because she did.

I came in anyway. It was almost 5pm.

Let me tell you what I saw when I got there: Exactly what she described without a single surprise. I examined the patient for myself, yes, but mostly? I simply came there to stand beside her.

I was standing at a computer scrolling through labs when she walked up. At first, I worried that she'd think it was because I didn't trust her. But as soon as she saw me, her face erupted into this complicated smile. "You came anyway," she said with a chuckle. Then she sighed this breath of relief.

"Yeah. I came to stand next to you. And worry with you. Is that okay?"

We both laughed and went to see our patient together. We talked to him and to each other and to radiologists and consultants. He was sick, too. And of all the people who looked the most relieved? He did. Having those two women standing side by side fretting about him on a sunny weekend day meant something.

I didn't say or do anything to change the ball my resident had put into motion already for this patient. It was she who saved a life that day--not me. I had nothing to add or change or suggest or modify. Nope. I just stood there, hands pushed down in my white coat pockets, nodding more than anything else.

Yup.

Sometimes my job as a clinician-educator calls for lots of high-level medical knowledge. Other times, not so much. Either way, I came in because now I get it. What holds true for most aspects of life is true here, too: Sometimes the most powerful thing you can do is just show up--show up, stand next to someone, and be there. And nothing else.

And this weekend, that's exactly what I did.

Yeah.

Confirmation.

“And who knows but that you have come to your royal position for such a time as this?” 

- Esther 4:14 NIV

A door had closed before her. It seemed like there was no way out. Some way, somehow our paths crossed.

She was miles away on the eastern seaboard and had somehow found my email. “I went to Clark Atlanta,” she said over the email. And that was when I knew. This medical student looked like me.

No. She wasn’t at my institution. But something about that message grabbed me that day. Was it the first such email I’d received asking for my help or attention? No. But something about this felt different. It’s hard to explain.

I was in Jury Duty so things were still. Her email crossed my box during an idle period and, as fate would have it, afforded her my full attention. I don’t think that was by accident.

Nope.

Emails went back and forth for about 30 minutes. Then this lady with a flat voice spoke into a microphone. She rattled off some names in a monotone voice. “If I called your name, your case has been settled. Thank you for your service.” One of those names was mine.

Yup.

An unexpected window. What to do? Call her. That’s what God laid on my heart. Her number was at the end of the email. Before I could overthink it, o decided to be obedient.

What happened next—you wouldn’t believe it unless you knew me personally. But here is what I will say: I've always thought that that, just maybe, that one moment in time was pre-appointed long before I ever even thought of becoming a doctor. Maybe even before I was born.

The best part is that I could feel it in that moment. I could feel that the universe was telling me loud and clear: This is your Esther moment. And so I held on tight to that idea and pushed. Trusting and believing and touching and agreeing.

But then? Just like that, the door that I thought I could open for her closed. I fell to my knees crying that day. “I did what You said!” I cried. “I was obedient!”

A friend told me to be still. So I did.

And then, a door opened. Not the door I expected. An entirely different door opened by someone entirely different—but to whom I was connected. She opened that door in a whole different state. We hadn’t even been talking. I’d just been writing. And her reading.

Whew. It was so big, so divine that I still struggle to wrap my head around it. This wasn’t MY Esther moment. It was OUR Esther moment. A moment for which we were BOTH created.

Yup.

That girl from Clark Atlanta who cold-called me all those years ago? She walked straight through that open door and never looked back. Wait—I take that back. She only looks back to see who’s rattling the door handle trying to get in.

Today, as I was sitting alone quietly eating lunch at a soul food counter between rounds, guess who came up behind me and wrapped me in a hug? It was her. After all these years.

Dual board certified. An assistant professor and full time faculty member. Living the dream. At Grady Memorial Hospital of all places. Took everything in me not to cry into my black-eyed peas and collard greens.

“Wow.” That’s all I could say as she told me about all of the wonderful things she’d been doing.

“I will forever be grateful to you both. Forever I will.”

“And I will forever be grateful to God for letting us be there in that moment all together.”

She nodded and we hugged tight. Then I pulled her back, looked at her, and hugged her again. After that I snapped this picture to send to the other Esther so she, too, could feel all the same feels.

I do struggle sometimes with asks and recognizing my limitations. I can’t be everything to everyone. Sometimes I can’t be even a little something. But that moment taught me to just listen. Listen so that I know when I should.

Yup.

What an ordinary lunch at the Sweet Auburn Curb Market this started out as today. Just like that ultra ordinary day in Jury Duty back in 2012. Now I know that nestled in every ordinary moment is the potential for something extraordinary just waiting to happen.

And maybe—just maybe—you were created for a moment such as this.

Yeah.

__________
Happy Tuesday.

Breath regular.

On rounds the other day

Him: "You alright, doc?"
Me: "Me?"
Him: "Yeah you. You seem outta sorts."
Me: *smiles* "I'm in sorts I promise. Now tell me--how you doing?"
Him: "Feeling a little better today."
Me: "How's your wind?"
Him: "Way better."

I sit him up and carefully untie the back of his gown. On cue, he takes breaths in and out as I listen intently.

Me: "Lungs sound good." *moves around to front of chest* "You can just breathe regular."
Him: "I know."

After pressing my palm to his chest to feel his heart, I search his chest with stethoscope. Although it's not normal, it hasn't changed. Like always, he keeps making big gasps, forcing breaths in and out the whole time exaggeratedly.

Me: "It's okay. Just breath regular."
Him: "Sometimes you want to breathe regular but you can't."

*silence*

Him: "Miss Manning?"
Me: "Sir?"
Him: "You okay?"
Me: "I'm okay."
Him: "You sure?"
Me: "Just got some bad news today about a friend is all. A friend who passed."

*silence*

Him: "I'm sorry."
Me: "Yeah. Me, too. Was a real good dude. Through and through."
Him: "Damn. Shot?"
Me: "Nah."
Him: "Kids?"
Me: "Yup."
HIm: "Damn."

*silence*

Him: "I knew you was out of sorts when I seent you."
Me: *taking a drag of air* "Yeah. You were right."
After that we just sat there for a few moments in silence. Then my patient asked me about my friend and I told him a really funny story about him. We both laughed out loud.
Me: "That dude was wild."
Him: "Sound like he was cool as hell."
Me:  “That he was.”

*silence*

Him: "It's gon' be okay, Miss Manning."
Me: *eyes stinging and wanting to cry* "Yeah. Sometimes you want to breathe regular but you can't. You know?"
Him: *staring at me* "Yeah. . . I do know."

If you think the only ones doing the healing around Grady are the doctors and nurses? Think again. These patients save my life every single day.


Rest well, my friend. Praying we can all breathe regular soon.

Full circle.

What happens to a dream deferred?

      Does it dry up

      like a raisin in the sun?

      Or fester like a sore—

      And then run?

      Does it stink like rotten meat?

      Or crust and sugar over—

      like a syrupy sweet?

      Maybe it just sags

      like a heavy load.

      Or does it explode?

- Langston Hughes (1902 -1967)

_____________________________________________

1. In 1992, I applied to Emory University School of Medicine. And didn't even get an interview.

2. In 1992, I also applied to Case Western School of Medicine. Got an interview there. But got waitlisted for med school. And never came off the list.

3. In 1992, I started at Meharry Medical College--the school that felt right but that I feared attending because, after Tuskegee University, it would be my second historically black college. I worried it would hurt me in the future. I was wrong.

4. In 1996, I applied to Emory University School of Medicine for Internal Medicine Residency. And didn't even get an interview.

5. In 1996, I applied to several other programs for residency including one of the Case Western affiliates, MetroHealth. I took the interview there only because it coincided with my interview at The Cleveland Clinic. I ended up loving the program at CWRU/MetroHealth. Fortunately, they loved me back.

6. In 2000, I finished my residency at CWRU/MetroHealth and started my chief residency. That same year, I would be selected by the medical students at Case for honorary membership in Alpha Omega Alpha Honor Medical Society--one of the highest honors any medical student can achieve. At Case Western Reserve School of Medicine. The same school where I was waitlisted in 1992--and never got in. Yup.

7. In 2001, through a connection I made during my chief residency at CWRU, I applied for my dream job at Grady Hospital. Specifically with Emory University School of Medicine. The same place that didn't grant me an interview in 1992 or 1996. This time they not only interviewed me--they chose me.

Guess the third time was the charm.

One year ago today on April 24, 2018, I stood at a podium at the Emory University School of Medicine to deliver the keynote address for the 2018 Spring Banquet for their Alpha Omega Alpha chapter--a jewel in the academic crown for any medical student who achieves this distinction. When I finished I got a standing ovation. By the Emory students. By the Emory faculty attendees. And even by both the big Dean and the Dean of Admissions.

Talk about full circle, man.

And no. This isn't so much about Alpha Omega Alpha Honor Medical Society. It isn't. It's more about life and how delays aren't always denials.

Nope.

That standing ovation felt good. But now? Here's what I know for sure:

No matter how dope you seem, accolades and collective handclaps from others should never define you--only effort and hustle. Becoming is always better than being. The doors that close on you can and will create new paths that make your life what it is supposed to be.

Thank you, Emory University School of Medicine-- for rejecting me not once but twice.

Thank you, Meharry Medical College for building me into exactly the doctor I was supposed to be.

Thank you, CWRU for putting me on your wait list, not admitting me to your medical school in 1992 and ultimately allowing me to grow there after medical school as a resident.

But especially thank you, Mr. Langston Hughes, for making me curious way back in 3rd grade of what happens to a dream deferred. Turns out that last line is right:

It explodes.

*Boom*

__________________

"Becoming is better than being." - Carol Dweck

__________________________

#proudofmybecoming #growthmindset #smartswithouteffortisdead #putyourmouthpiecebackin #andstartswingingagain #itwasalwaysaboutgrady


Now playing on my mental iPod. . . 

The little girl who didn't cry wolf.

Your chest was hurting. This was your chief complaint. "Like pressure," you'd said. Then you shook your head and closed your eyes. Your hand pushed into the center of your chest for emphasis.

I asked what you were doing when it came on. You shrugged and insisted that it was nothing out of the usual. Then you scratched your shoulder vigorously. The suddenness of the gesture startled me.

"You okay?" I asked.
"Yeah," you said. "I just be itching sometimes."

I nodded. And then went back to the discussion.

Pressure like chest pain at rest that made you miserable enough to come to the emergency department. A little bit of shortness of breath. But not much. No numbness or tingling in your arms. You weren't exerting yourself in any way.

Nope.

And yeah. You USED to use crack. But not any more. You were adamant.

"I fell to my knees," you said. "I was so tired, Miss Manning. I fell to my needs and asked God please. Please take this stronghold away from me."

I kept listening. Almost feeling like I didn't deserve to be on the other end of this testimony given my mood. My team was surrounding me during this conversation. They followed my lead, saying nothing.

You went on: "Then? Just like that. He took it away from me. I swear. It's been three whole months. THREE WHOLE MONTHS." You repeated that last part.

"Wow," I said. My 'wow' didn't sound wow-ish. It sounded mechanical and fake. My hand was rubbing the side of my neck. I was listening to you and watching you. Your eyes were dancing and your hands were animated. The laxity of your jaw as you spoke reminded me of the many heavy crack users I'd seen over the years and the patient years ago who pointed to Bobby Brown on the television and said, "That way he move his jaw like that? That's when you use a whole, whole bunch of crack." So yeah. This was what I was thinking about. The whole time that you were talking about what God had taken away from you.

Sigh.

I didn't fully believe you. Not that I didn't think you believed what you were saying. But I was tired. Very tired this day. And I just needed something to just bark exactly like a dog and say, "Hello. My name is Fido."

Sigh.

The third year medical student, however, was new to this. He'd heard your story and presented you to me as the last patient at the end of a busy day. And every drop of your kool aid, he'd lapped it all up, gleefully reporting your newfound abstinence. "I believe her," he said about you. His young face was emphatic and his greenish eyes glistening with advocacy and defiance. He repeated himself. "I believe her."

I wanted to. But my bias against you was so strong. And I was tired. Like so, so tired. Not take-a-nap tired. But emotionally tired of watching how this sickening crack epidemic decimated my people and how it was all beginning to feel like a hopeless version of that movie Groundhog Day.

Uggh.

I remembered what I'd learned about ways to fight bias. Being aware of triggers like exhaustion and such. And so I held your hand and did the things we do for chest pain. I nodded my head and mumbled words of affirmation about God's intervention like "Won't He do it."

Then I said sorry in my head right after that. To God for fronting and using his name in vain.

"We didn't check a urine drug screen," the student said outside of your room. "I mean, we can. But I will be so disappointed if it's positive."

I was tired. So I just dragged a breath of air and said, "Me, too. But still. Check it." Which he did.

Yeah.

Today when I came to see you, you looked so happy to see me. Your face was still full of light. The gladness in your eyes to see this black woman doctor was palpable. I could see it before I even turned the light on. "My doctor! Heeeeey Miss Manning!"

You reached for my hand. I grabbed it. "Hey sis," I said softly. Then I sat down. My face was serious. And my eyes almost immediately welled up with tears.

"What?" you queried. Your eyes looked worried. About ME. "What?"

I swallowed and gained my composure. "I owe you an apology." Your eyes widened. "I. . .I just got back your urine drug screen. The student didn't want to get it. But I insisted." You kept listening. "It was negative."

The expression on your face was inexplicable. Then what you did next surprised me. You held open your arms and asked for a hug. I obliged you.

"You be wanting to believe, don't you? But you can't always believe."

I nodded and sighed. "I do want to believe. I do."

"It's okay. That's the thing about a stronghold. It make reality and fantasy look like one and the same. Bet you heard a whole bunch of folks cry wolf before."

I tapped my foot and bit my lip so I wouldn't cry. "I am very proud of you. And so happy for you."

"And I believe you," you said. Then you squeezed my hand.

When I left your room, I went to a stairwell to cry. Mad with myself because every day I am preaching to my teams to believe that today could be the day. Here "today" was staring me in the face and my bias and exhaustion wouldn't let me believe it. Or at least try to believe it.

Sigh.

No. I don't have all this shit figured out. No, I do not. But you were right. I be wanting to believe. Damn, I do.

Yeah.

P.S. I told my medical student I was sorry, too.

***
Happy Wednesday.

Sister and the Warrior.

*as always, details changed to protect anonymity.

Afternoon rounds last week

Her: "Did you feel nervous when got that?"
Me: "When I got what?"
Her: *points at my wrist* "That."
Me: "Oh this? First yes. Then no."

*silence*

Her: "Wow. I never saw a doctor with a tattoo on her wrist."
Me: "No?"
Her: "Nope."
Me: "So. . .I'm curious. How does that make you feel?"
Her: "I'm young. So it mostly make it seem like you cool."

*laughter*

Her: "Nawww, but real talk? I think it just make me know you a person."
Me: *listening*
Her: "Like, to me, a tatt supposed to tell a story. Like, it should mean something."
Me: "I like that."
Her: *pulls gown off of shoulder* "See this one? It say 'WARRIOR.' Because I been through so much with my health but I come through stronger every time. I'm always gon' fight back!" *kicks foot out of sheet to show her foot* "This one on my foot say 'Follow my footsteps.' That one remind me that even though some people let me down when I was little, I ain't no victim. I can create my own path, follow God's path and be somebody other people want to follow, you know what I'm sayin'?"
Me: "I do. That's dope."

*silence*

Her: "I mean, you gotta be careful about where you get ink. And what it say. But you also got to do you." *covers feet back up with covers* "And you can't be drunk or nothing."
Me: *nodding* "I know that's right."

*fist bump*

Her: *points at my wrist again* "Okay. So what's the story behind that?"
Me: *turning my wrist to look at it* "Well. . . I lost a sister."
Her: "Oh man. Sorry."
Me: "Yeah. But she was awesome so I like remembering her this way. I also have another sister living. And I'm forever a sister to her, my sister who passed and to my brother. I believe in women having tight bonds so I'm a sister to my women friends. And then there's my sorority. . .that's another sisterhood I'm in."
Her: *smiling* "That's what's up."
Me: *still looking at my wrist* "Yeah. I was gonna put it somewhere else at first. But then I realized that I wanted to see it every day. So I put it here on my right wrist."

*silence*

Her: "See? I told you a tattoo make people know you a person."
Me: *laughing* "I'm not so sure everyone would agree."
Her: "I think sick people don't care about that. They just want to know you a person who care and not a robot."

*silence*

Her: "I saw that and you know what I thought?"
Me: "What's that?"
Her: "That sister gon' take care of me. 'Cause she got love in her heart for somebody."

*silence*

Me: *wanting to cry so bad*
Her: *just staring at me smiling*

She seemed like she knew I wanted to cry.

*silence*

Her: "I love your tattoo, Dr. Manning."
Me: *staring at my wrist again and smiling* "You know what, little sister? I love it, too."

Sigh.

Damn, I love this job.

***
Happy Monday.

I love you x 3.

There was this older gentleman who'd been admitted to my team and his admission was soft. We call admissions "soft" when someone was on the fence about whether or not to keep the patient hospitalized or send them home. But anyways, he got admitted and his issue was quickly sorted out and the very next morning he was ready for discharge. Nothing about his problems were exotic or earth-shattering.

Nope.

We actually didn't see him as a team on rounds that day. His issues were so straightforward that I'd agreed to see him on my own. He was nice enough and didn't have many questions when I got to the end of the encounter. And so. I reached for his hand and wished him well.

And that was that.

Well. Not really. I always like to find some way to connect with my patients or to show them I have an interest in them as a person. This patient was pretty quiet so it wasn't exactly the easiest thing in the world. I tried anyway.

"Is someone in your family coming to pick you up?" I asked. "If not, we can arrange a ride for you."

"My sister will be coming to get me. I'm okay with the ride part."

"Okay," I responded. I smiled and prepared to stand up from the bedside chair. "Do you have children, sir?" 

At Grady that question feels rhetorical--especially when talking to the elders. Of course this man had children. He probably even had grandchildren and great-grandchildren.

"No, ma'am. We never had children."

He said 'we' not 'I.' Hmmm. So I bit. 

"Were you. . . previously married?" I kind of wanted to smack my forehead after saying that. I was relieved when he didn’t seem to take offense to that question. 

"If I could have been, I would have been." 

He stared out of the window and his eyes began to glisten with tears. I wasn't fully sure how to proceed but I hungered to know from where the emotion was coming.

"Tell me more." That's all I said, sitting myself back down in preparation for his response. Vanilla enough. Forward enough. Maybe even too forward, but I didn't want it to be mistaken as anything other than the question it was.

Nope.

He turned his head and gazed at me. This soft-spoken man who'd uttered very few words since his hospitalization touched his fingers to his lips and then pressed them together to hold in the first thing even close to a smile that I'd seen since walking in. "My love. That is a good word for him."

Yes. Him. Aaaah.

"Do you mind telling me more?" 

He smiled and shook his head. Then he began to speak.

"His name was Morris. He was funny and loud and a really, really good dancer. He wasn't afraid of anybody, either. We met when I was still a teenager but we were inseparable. He didn't care what people thought about him loving me, either. Nobody."

"Wow. How long were you together?"

"More than 20 years off and on. He went to the military for a little while and I lived out west for a couple of years. Then we came back together."

"Morris sounds amazing."

"He was. I took care of him until he took his last breath. I held his hand and stroked his cheeks and just kept on saying 'I love you, I love you, I love you, I love you' until his last moment." He started blinking fast to remove the tears that were quickly forming. Then he sighed deep and hard. "He was so, so brave. He was the love of my whole life."

I was already crying. I patted my own cheeks and smiled. "I love that you just kept saying 'I love you' until the moment he died. That's probably one of the most beautiful things I've ever heard."

"It was so hard being gay back then. There weren't people clapping at parades for us, either. Especially in Atlanta. But Morris always said that life was short and that we needed to live. He said we deserved love and I believe he was right. One funny thing he always said was, 'You don't want to hear about, talk about or imagine your mama and her sex life. Why the hell you got your drawers all in a bundle about mine?'" He let out a moist chuckle and then quickly looked wistful. "He made me brave, too."

"Wow. What happened to Morris?"

"He died of AIDS. Back before they had all the stuff they have now. I got lucky somehow and didn't get it. But his family was scared of him and they weren't nice. That's why I wanted the last words he heard to be 'I love you.' I must have chanted those three words for more than six hours straight. I'm not kidding you. He was in and out of consciousness but I just kept on. Sip some water and then say it again. And again and again and again."

"I love you, I love you, I love you. I can think of no more beautiful way to make a transition."

"I pictured him hearing my voice and then God taking over with the same words." He looked over at me and smiled. I could tell that he was serious.

"Me, too." And with that my voice cracked and I started full on crying. I sure did. And he handed me his tissue box off of the tray table and I took three pieces. And then we just sat there imagining Morris escaping the pain of horrible stigma and ignorance and not being accepted and advanced AIDS and just feeling free and loved. Following the sound of those three soul-fulfilling words.

I love you, I love you, I love you.

It was perfect, that moment. Perfect in how unexpectedly beautiful and pivotal it was. Every time I imagine him standing vigil over his brave Morris saying, I love you, I love you, I love you, I cry. And it feels good, too, because I know I'm honoring their love and that moment that I had the chance to be introduced to it.

I love you, I love you, I love you.

Yeah.

A cup of joe.

Today was my day to drive carpool. That makes my morning crazier than usual and the struggle even real-er than it is at baseline.

Grrr.

I was hustling out the door so fast that I spilled half of my coffee in the driveway. Which, if you know how much I love a good cup of joe in the morning, is a really big deal.

Grrr.

I got stuck behind a train. Right by the kid's house that I was already running late to get. And fortunately, his mama is cool and so is he. But still. That mixed with no coffee wasn't my favorite.

Grrr.

I forgot my gloves. And I have those hands that turn fifty shades of ghastly grey when cold. They hurt, too. So after dropping kids off, I kept doing this thing where I'd stick one hand under my thigh while driving with hopes of the car seat warmer toasting it up. Let me tell you something: That doesn't work so well.

Grrr.

The Grady garage was already filling up. Which was annoying considering it wasn't even 9am. I circled up and up and up until I reached the roof. That is, the 10th floor. Which adds like 7 minutes to your commute home. And that's a lot when you are almost always on two wheels trying to get to a kid during hospital service time. Did I mention that I spilled almost all of my coffee?

Grrrrr.

Like always, I felt a little better when I got to work. But that was short lived because my office door was locked when I got to it. Which, for most people, is no big deal. But for me it is since I don't like my office locked nor do I carry around the key.

Grrrr.

Bump it. I decided to just grab my white coat and roll out across the street to the hospital. Fortunately, Linda, this super nice woman on our admin team had just made a fresh pot of coffee. She waved her hand from her cubicle and told me she could feel that I'd want some. She was right.

Sigh.

I pour a piping hot cup to go. Carefully, I place a top on it to be certain, certain, certain that I wouldn't spill it. My colleague friend waited for me beside the elevator because he was going to round, too. And we chatted about our teams and my icicles (both figurative and literal) started to melt.

Whew.

So we strut out of the office building and the cold hits us in the face like a mad ass pimp. (Yeah, I said it. Because that's what I was thinking.) But even that was fine because I had this really, really hot and really, really fresh cup of coffee that Linda had put love into. She even told me that I could have some of her fancy creamer if I wanted. I added a tiny splash. Which gave me something to look forward to.

Yup.

So we were just walking and talking. Really fast, too because it was, to quote my dad, cold as adunnawhat. So we are hustling quickly with our white coats pulled super tight. Making our way into Grady before freezing in place.

That's when I heard it.

"'Scuse me! Miss Doctor? 'Scuse me!"

I stopped and turned around to face him. It was the voice of what appeared to be a man at least 20 years my senior. This elder appeared to be living out in those elements. Shit. I braced myself for him to ask for cash. And immediately wished I'd placed a granola bar in my pocket.

Grrrr.

"Um, could you tell me where I can get coffee?" he said.

He had his hand wrapped around himself, rubbing his bony shoulders. His coat was not warm enough. Not at all.

"Um. Let me think,"I replied. "We have a coffee shop inside."

"Oh. Okay, thank you, hear?" He didn't walk toward the entrance, though. Instead, he turned the other direction. Maybe it was because he didn't have cash. I'm not sure.

I thought about just walking him into the coffee shop to get him a coffee. But I knew that, one, my team was waiting. Two, the line was going to be long at this time of day. And three, I never give cash money outside of the hospital. Plus I didn't have any money on me anyway.

Sorry, sir. That's what I said in my head before continuing on my way. We resumed talking and walking. I looked back over my shoulder as my brisk footsteps took me further away from him.

Then, I felt something. It was like God Himself grabbed my shoulder and said, "What about your coffee?"

"This one? With the special splash of creamer? Dude. Seriously?"

I stopped in my tracks. Spun on my heel and called out. "Sir!" He turned around. "You want my coffee? It's hot. I just got it."

His eyes widened. That's when it occurred to me that he never intended for me to do THAT. He just hoped I knew of some magic place to hook a brother hard on his luck up with a cup of coffee. Turns out I did.

"Oh yes. I would really, really like that," he said. And I knew when I put it in his hand that I would be going to round and into my day without that yummy special creamer and minus that perfect backup cup of joe.

Did birds start chirping and heavens open up? Nah. But that was okay. Because maybe, just maybe, God showed HImself to me today. And you know what? I saw Him.

Yeah.

***
Happy Wednesday.

Scrappy.

"Baby, you will rise. Limit is the skies. 

Don't you let nobody fill your head up with their lies."  

- Amel Larrieux

I was once sitting at a table after giving a lecture as a visiting professor at a medical institution. I'd mentioned in my talk about how I'd applied to Emory for both medical school and residency but how I wasn't granted an interview either time. How my grades were good but my standardized test scores weren't at a high enough percentile to make the cut. Then I went on to share how later I would join the Emory faculty and build a successful career there--in spite of all of that. The message, geared toward medical students primarily, was about grit and resilience--both of which are critical to the success of any physician. They seemed to receive it well.

Over coffee and dessert after the lecture, I made small talk with the nearly fifteen senior faculty members, medical students and esteemed guests sitting at my table. Of all the people there, not a single one looked like me. Or even close to like me. But still. They spoke kind words of affirmation and asked polite questions. And I answered them all and it was fine.

But then, this happened. A subtle microaggression straight from the mouth of a grey-haired full professor who, I guess, meant well.

Him: "Your talk was so inspirational. Thank you for that."
Me: "Thanks. I appreciate your kind words, sir."
Him: "It looks like things really worked out for you. I guess I'm just wondering how we zero in on the ones like you and not overlook them. When they don't quite meet the standard, how do you reconcile that?"

*silence*

Me: "Well. I guess the first thing I will say is who defined the standard? Perhaps that standard isn't the best measure for everyone. You know?"
Him: "I'm not sure I understand."
Me: "People like me weren't there when those standards were being created."
Him: *still not getting it* "I hear you. But I guess what I am wondering is how do you know that, if you DO take a chance, someone will be scrappy like you were? How do we not pass on the ones like you? The diamonds in the rough?"

He smiled showing all of his big, yellow teeth. I did not smile back.

*silence*

Me: *in my head* "Did this dude just call a visiting professor 'scrappy' and 'a diamond in the rough?'"
Me: *out loud* "Sir, where I came from? I was able to shine from the very start. I got my education at Tuskegee and at Meharry. I always was a diamond right out in the open. I was never in the rough. Not then and not now."

I swallowed hard and held his gaze without smiling. He needed to know that I wasn't kidding. Because I wasn't. And even though a tiny piece of me wanted to cry, I pushed it down because even if he didn't know and even if they didn't know way back when, I was always enough. Always.

After that, we all sat in an awkward silence. Me sitting with my spine stick straight with a relaxed facial expression. And him, along with several others, looking nervous and apologetic.

I let them squirm.

I didn't say much after that. I was pleasant for the rest of the dinner and was gracious to my hosts when I left. Even the grey-haired dude. But here's what I wish I'd said:

"You know what? I am scrappy. But not the kind of scrappy you think. Scrappy in that I know who I am. Scrappy in that I know how to put my mouthpiece back in and fight even when the fight isn't fair.

That kind of scrappy.

And also. . . you, sir, don't get to call me that. Because just maybe the 'rough' you speak about is in your eyes and was never the students like me at all."


People say some crazy stuff sometimes.

Yeah.

***

He hurt my feelings. But that's okay because I'm scrappy. Now playing on my mental iPod. . . 

60 seconds.

"All I need is one minute of your time." - Mary Mary

____________________________________________

Sunday rounds today, my senior resident and me


Me: "What questions do you have for us?"
Her: "I don't have any questions. Y'all answered them. Thank you."

*smiling*

Me: "Okay. Is there anything else you need from us before we go?"
Her: "May I have one minute of your time?"
Us: *looking at each other*
Me: "Sure. Tell us what you need."

She extended both of her hands out toward us, gesturing for each of us to take one of them. We did.

Her: "I'd like to pray for you. Is that okay?"

My breath hitched. I didn't want my resident to feel pressured or uncomfortable. Had I been alone, this would have been a no brainer. Fortunately, my resident didn't seem to mind.

Our patient then closed her eyes and clasped our fingers inside of hers. Softly, deliberately she petitioned on our behalf. She spoke over our careers, our families, asked for our protection, patience, wisdom, compassion and that we be empowered with the energy we need to keep going. She asked that no weapons formed against us ever be able to prosper and that we always, always recognize that we have been commissioned as healers.

Commissioned as healers, she repeated.

After saying amen, she hugged us one at a time, tangling us up in her IV and oxygen tubing. It was so tender and genuine. It was like she had made up her mind to infuse us with as much grace as she could possibly muster.

"I receive this," I told her. "Thank you so much."

"Let Him use you," she said.

And we nodded in response.

If you had any idea the things that this patient was battling, you'd fall to your knees crying. I'd hoped she'd ask me for something like an ice-cold Coke from the vending machine. Or a pack of gum. Or even a latte from the coffee shop. But instead, she wanted to give.

To give, man.

The older I get, the more I recognize that a heartfelt gift often blesses the giver more than the recipient. I'm not sure where my resident stands when it comes to faith, but I love that she was gracious and welcoming of what our patient had to offer.

Yeah. That.

That reminds me: A friend of mine who doesn't believe in God once said, "But that doesn't mean I turn down folks praying for me. I need all the prayers I can get." Remembering that made me smile and wonder less about my resident.

Yeah.

We finished rounding in time for me to scoot across town to join my family for church service. As I slid into the pew to join Harry, all I could think of was this tender prayer spoken over my life and that of my family by a critically ill patient who had every right to think of no one but herself.

Whew.

I closed my eyes. Lifted my hands. And decided to return the favor.

Yeah.

***
Happy Sunday.

Now playing on my mental iPod. . .

Why.

There was a code blue on the ground floor. Weird considering no code blue is ever called there. I mean, not that they don't happen there. But it never reaches the overhead sirens since almost always it is happening in the emergency department where everyone is already there and ready.

Weird.

I was on the tenth floor when I heard it. Typically those nearby run to get there. In case they are the first responders, the rule is to try. I wasn't near. But I did wonder what it was all about. Grady is busy, though. There's lots that I wonder about. And then I go on to thinking of something else.

Yeah.

A few hours passed and I was up in a patient's room. He was an elder and I'd come back to check on him one more time. The patient in the bed next to him was talking about what he thought had happened. "Somebody got shot in front of Grady," the roommate said.

"Really?" I replied. "Oh my goodness. I didn't hear that."

A nurse in the room turned away from what she was doing and chimed in. "No. That's not true. Some young brothers pulled up with somebody who'd been shot. Dumped him right on the curb in front of Grady like some luggage and pulled off." She shook her head with hard disapproval. "That's a damn shame, right?"

"Wow." That was all I could think to say. I wondered if my family and friends had heard this on the news and were worried. "So . . .no one was actually shot in front of Grady?"

"No, I don't think so, But isn't that awful? Just throwing somebody on the ground not caring if they live or die? And pulling off before you could see what happened?" She sucked her teeth. Hard.

"You said 'brothers,'" my patient said. The nurse paused, balled up her espresso-colored fist on her hip and curled her lips at him in response. She didn't speak--instead she just cocked her head for emphasis. My patient turned back toward the television and said nothing else.

"That's just TERRIBLE." That's what the neighbor-patient said. Then he said it like five more times in case we didn't hear the first time.

"Wow," I mumbled. Again, because I still couldn't think of what else to say.

After that it was silent for a few moments. That nurse wiped my patient's fingertip pad with an alcohol wipe and pricked it with a lancet. He winced. She rubbed it in this tender way that showed that she cared about his discomfort. I liked that.

"Man. I hope the guy who got shot did okay," I finally said.

The nurse kept shaking her head angrily. Then she moved on to flushing my patient's IV line. "Me, too. Such a damn shame," she said. "Who does that?" The roommate made a few more comments about "not knowing where this world is coming to" and "letting our ancestors down."

No one disagreed.

Finally, my patient, a Grady elder, spoke:

"Look to me like them kids who dropped him off cared a whole bunch about whether he live or die. Bet you they somewhere distraught about they friend."

"Friend?" the nurse said. Her face looked disgusted and her lip jutted out. "FRIEND? With friends like that, who needs enemies?"

The Grady elder turned his head in her direction and looked at her; his face impassive. "If you didn't give a damn about somebody, would you bring them someplace where you KNOW they'd do everythang to save they life if they got shot?"

He kept his eyes trained on the nurse. We all stayed quiet. He raised his eyebrows and went on.

"Look to me like that was they man. Somebody they really cared about and hoped would be okay if you ask me." He shrugged and started fishing around in the sheets for his remote control.

I stared at him, taking in every word. I didn't want to miss a thing. The nurse was frozen in her tracks and the neighbor had (finally) stopped talking. All eyes were on the elder.

"The real question is this: Ask yourself WHY would some young brothers in a city like Atlanta feel scared to bring they friend into Grady after he got shot? WHY would they not be willing to stay long enough to make sure they friend don't bleed to death? You really thank it's 'cause they don't care?"

When nobody had a reply, he let out a chuckle and shook his head. His expression suggested how naïve we sounded.

After that, he turned his television back up and settled into The Steve Harvey Show. And didn't say another word. But you know what? He didn't have to.


Damn, I love this job.


***
Happy Sunday.

Keep it to yourself.

I was sitting at the nurses' station typing notes the other morning. One patient caregiver with curly hair pulled into a puff on top of her head was standing at the printer. Another patient caregiver wearing rather tight scrubs walked up holding some IV bags and tubing. I knew them both well so looked up, smiled, and returned to my charting.

Scrubs: "Hey girl."
CurlyPuff: "Hey. This printer is tripping."
Scrubs: "Turn it off and on again. That's what I do."
CurlyPuff: "Okay, cool."

CurlyPuff shut off the device and waited for it to turn back on. She stood there with her hand on her hip looking impatient. It was clear that she was busy and a faulty computer was throwing a speed breaker down in her flow. She sighed. I glanced up from my seat at her briefly in solidarity because I knew exactly that feeling.

Scrubs: "You know what? You look tired."
CurlyPuff: "Tired?"
Scrubs: "Yeah. You look tired."
CurlyPuff: "You mean like sleepy?"
Scrubs: "No. Like. . .tired. Like I'm looking at you and thinking, 'You look tired.'"

CurlyPuff turned her body away from the printer in Scrubs direction and just stared at her for a moment. Her face made it clear that she didn't care for that observation.

Here we go.

Scrubs: "I say it out of concern."
CurlyPuff: "That I look tired? Not sleepy but tired?"
Scrubs: "Yeah."

CurlyPuff keeps staring at Scrubs. She looked up and down at her without expression, blinked slowly and sighed again. Then she spoke back.

CurlyPuff: "You look like you gained weight."
Scrubs: "What?" *looking embarrassed*
CurlyPuff: "You do. Like I'm looking at you and thinking, 'Your scrubs are getting tight. You look like you gained weight.'"

Oh snap.

Scrubs: *looking offended* "Wow. Remind me to never say anything to you."
CurlyPuff: "No. Remind yourself never to walk up to a woman, look her in the face and say something like that. At least, not like that. That she look tired? Not sleepy but tired?" *shook her head and patted the side of the printer*
Scrubs: "I was saying it out of concern."
CurlyPuff: "Just 'cause you think it don't mean it need to be said. What I said to you was something I thought before. And it could be out of concern, too."

Oo wee.

Scrubs: *speechless*
CurlyPuff: *putting arm around Scrubs* "Look, baby. That just ain't the thing a woman can receive in a way that make her feel better. Nor do it make a woman feel good to hear that--especially coming from another woman. That she look tired? Naw. Just ask how I'm doing. See about my needs if you concerned. But don't walk up on the hall and announce out loud that I look across-the-board tired. That didn't make me feel good."
Scrubs: "I'm sorry."
CurlyPuff: "Me, too, girl."

They hugged it out. And after that, the printer started working again, too.


Damn. I love this job.

***

*For the record, I'm not a fan of being told one looks tired either. Honorable mention: "Fun" to describe hair, clothing or anything else that you were being dead serious about when you put it on.

***

More on bias.

I think so much about bias. About MY biases. About OTHERS' biases. And about all that happens as a result.

But these days? I mostly just spend time unpacking my own biases. Trying my best to have the courage to make my implicit biases explicit to me. So that I can start doing the work to be my best doctor and person.

Yup.

This is exactly what I saw in the Grady emergency department the other day:

1. An elderly black woman was sitting in a wheelchair having her blood pressure taken by a nurse. She had a blanket over her shoulders and her grey hair was in plaits. She kept dozing off. Her ankles were very swollen. Her nails had been painted with a bright color by someone.

2. On the other side of the room, this young white man was sitting on a gurney with his legs dangling off of the ends of it. HIs shoes looked very new. And very expensive. He was staring at a smart phone, periodically sighing super hard. I was thinking it was to let everyone know he was tired of waiting. But maybe he was sighing for a totally different reason.

3. Somebody was hollering behind a curtain. Like, super loud. All of a sudden, that hollering person ripped back the curtain and looked around. I made eye contact with the person--a very slender woman with pale skin, stringy hair and really, really bad teeth. Her eyes widened when she saw me looking and her hollering started being directed at me. "DOCTOR! ARE YOU MY DOCTOR? DOCTOR!" she screamed. I wasn't her doctor. I slid behind a column out of her line of sight.

4. A Spanish-speaking woman and man were sitting together in one chair. He was on the chair and she was on his lap. She had an IV in with nothing running into it. And he was wearing what appeared to be clothes from a construction site. I don't speak Spanish, but I could tell they were concerned. And tired. But he was making her laugh. And every time she laughed I could see the gold rimming her front teeth. A few moments later, he was falling asleep, too. Just like that elder in the wheelchair.

5. A gender-nonconforming hospital employee walked by. Smiled in my direction and said, "Hey Dr. Manning." I said hey back, but the greeting given to me was so warm and familiar that I felt too ashamed to ask for the name I probably should have already known. I'd seen this person many times before. I noticed a new facial piercing this time.

6. A big commotion came from up the hall and in comes two uniformed officers with a lean, muscular young man with hands cuffed behind him. He isn't resisting, just looking really mad. He was shirtless and his beltless pants were nearly falling down. HIs hair was in locs--part brown, part blonde--and they shook every time he moved his head. Even though he wasn't fighting those officers, it seemed like they were fighting him. He caught me looking, too. He stared at me, almost like he was daring me to judge him. For some reason, with him, I didn't move behind a column. I just tried my best to make my eyes as soft as possible. He looked a lot like my youngest son.

All of this was in the span of 60 seconds.

Yup.

My bias was at play in every single one of those scenarios. Since I know that now, I see stuff so differently. My friend Shanta Z. and some others have helped me a lot with getting more woke in this aspect. Now, after moments like this, I walk around asking myself stuff like:

Who are you?
What are you afraid of?
What are afraid other people are afraid of?
Who are you trying to protect?
Who are you not trying to protect?
What are you mad at?
What are you sad at?
What makes you feel at home?
What makes you feel lost?

And the list goes on and on.

And yes. I say this stuff to my learners, too. Not to hear their answers. But just to get them seeing what I see, too. Or seeing what they see, too.

Yeah. That.

America is a bugged out place, man. And if you think white folks are the only ones trying to sort through their implicit and explicit biases, you just met someone who will help you to stop thinking that.

The answer to all this? Shit. I don't know. But acknowledgment is a start, man. I just want to be better. Do better. Be brave.

Yeah. That.

***

Me and mines.

Mines.

Last month on rounds

Her: "Before you say anything, hold on for a second, okay?" *fishes around in bed for her phone* "I need to get my sister on the phone." *opens flip phone*
Me: "You know. . . . if you want, we could call her for you. You know. . . and update her on everything."
Her: "Nawww. Let me go on and call her right now, okay?" *holds up index finger telling me to wait*

*inward cringe* 😬

CONFESSION: The whole "let me get somebody on speaker phone" thing in the middle of rounds is so not my favorite. Like, at all. For one, I don't enjoy having to speak louder and more animated to bring someone else into the discussion. And lastly, by definition, people on the phone seem to need more to make up for not being able to see your face and expression as you talk. It can get lengthier than normal. Which isn't always so fun when you're super busy.

Terrible, I know.

But I do have a workaround. The compromise for me is that I offer to personally call that loved one afterward. And usually that's fine. This time? Not so much.

Me: "You sure you don't want me to just call her directly? I am happy to do that, you know."
Her: *chuckles* "See, if it was just up to me? You calling her later would be fine. But that ain't the case."
Me: *inward cringe* "Okay."

*silence as she scrolls through her contacts*

Her: "See, my sister? She don't play. She like to hear WHAT they telling me WHEN they telling me. She said she don't like no after the fact summary for the family, you know?"
Me: *presses lips together and nods* "I can see that."
Her: "Some doctors don't like all that, though. They ain't patient like you."

*inward cringe*😬

Her: "Like, this one surgeon? I said I need to call my sister and he flat out said, 'Your sister needs to be up here if it's that important to her to hear every single thing play by play."
Me: "Whoa."
Her: "That dude was talkin' 'bout some, 'You want to be IN the game? You got to be AT the game.' He started laughing, too. Like he said something funny."
Me: "Wow."
Her: "What's messed up is that I laughed, too. Even though that wasn't funny."

*silence*

Her: "Let me tell you what else wasn't funny though--when my sister called to ask me why I ain't call her when them surgeons came by and I told her what he said. You know, about the game and all."
Me: *squinting eyes and wincing*
Her: "Baybaaaaaay."

*laughing*

Her: "When I say she took the WHOLE DAMN DAY off from work the next day to wait for his ass? Girl, like a damn playground bully after the school bell!"
Me: *laughing*
Her: "That dude walked in and she was like, 'Oh. You the one who said that stuff about me being in the game, right?' He called his self laughing it off, too. She was like, 'Let me tell you ONE GOT DAMN THANG about ME AND MINES!'"
Me: *eyes widening and erupting with laughter* "She didn't go to the 'ME AND MINES' did she?"
Her: "Girl, he ain't knew that when somebody black say 'ME AND MINES', it don't NEVER end well."
Me: *doubled over*
Her: "Dr. Manning! She was like, 'OH. ME AND MINES? We ONE BALL, boo boo. I'm in EVERY GAME, you hear me?' Patting her chest, looking all crazy and all up in his face." *laughing and shaking her head* "Lawd. That po' man."
Me: "Wait--did she really say 'boo boo?' 
Her: "SHOLL did."

*hollering laughing*

Her: "Chile, for the rest of that week that man was calling my sister so much she got sick of him!"
Me: "It was the 'ME and MINES' that had him shook."
Her: "Please believe!"

*laughter*

After that, she pushed a few buttons and then put her sister on the speakerphone. We all talked about what was happening with my patient--her sister--and what to expect next. Sister was tough--as expected. She asked a ton of questions and with each one, my patient rolled her eyes and shrugged in my direction. Eventually, all the questions were asked and answered. And all was well.

Yup.

Was it awkward to be talking in Dolby stereo over an antiquated flip phone? Of course. But did I do it? You're damn right.

I'd be lying if I said that now I've had this epiphany about how much I'll now enjoy bringing in family on speakerphones during rounds. Nope. But I CAN say that I haven't stopped thinking about Sister's reason being that she wanted to hear EXACTLY what the doctor said to her sister EXACTLY when they said it. This was advocacy on a whole different level.

I remember when a family member thought she had uterine cancer because of the way her fibroids were described by the doctor on rounds. "Tumors on her uterus," they'd said. Which, to her, meant cancer. I wonder what those 72 terrifying hours of thinking she had cancer would have been like had she insisted I get brought in on speakerphone that day. . . .

Me and mines.

So this? This is why I take a moment every day to sit and think about what's going on around me. To let empathy push down my selfishness and remind me that you and yours are as important as me and mines. And that we ONE BALL.

Yeah.

"I'm in EVERY GAME, you hear me?" 

- a badass baby sister who took exactly ZERO mess from anybody.

****
#amazinggrady #idontmakethisstuffup #meandmines #supportisaverb #standbyyourfolks #andstayinthegame

Come together. Right now.

"Come together right now. . .over me." - The Beatles

Partner: "Can I speak with you in private for a moment?"
Parents: "Can we speak with you in private for a moment?"
Partner: "Don't mention anything to his parents about this but. . ."
Parents: "Don't mention anything about this to his girlfriend but. . ."
Me: 😬

One person expressed one thing. Somebody else expressed something altogether different. Everybody loves him. But the messed up part is that those people that all agree on loving him, agree on very little else.

Nope.

Are they rude? Nope. Screaming and hollering? Not so much. But mostly, the room is just filled with this icy coolness when I walk in. If everyone is there at the same time, count on it to be filled to the brim with passive-aggressive nice-nastiness.

Yup.

Partner: "I just don't even try with them anymore. They think they know what he wants and needs but they don't. They barely know him."
Me: "How long have you all been together?"
Partner: "Oh goodness. Easily ten years. We might as well be married.”
Me: "Gotcha."
Partner: "Essentially, they don't like me and I don't like them. So we never talk. I mean, he talks to them, but I don't. I steer clear of them as much as I can."
Me: "I see."

*silence*

Partner: "Well I know they're saying they want to do one thing when he leaves here. But that's not what I want to do. I want something else and I think he'd want me to make that decision."
Me: "Have y'all talked about it? You and his parents?"
Partner: "I tried to be polite. But they always thought he could do better than me. Like they wanted him to get married and have a wife who was skinny and went to college somewhere and who don't got any kind of background."
Me: "Hmmm."
Partner: "That ain't me. So far as I was concerned they could kiss my ass."
Me: "Dang."
Partner: "Now since he can't speak for himself, they all high on they horse. That's some bullshit."

*later in the same day*

Parents: "Thanks for talking to us."
Me: "No problem."
Parents: "We plan to take him home with us after this. We have a lot of good things to assist him on getting back on his feet."
Me: "I see. I know he has a live-in partner. Have you all talked to her?"
Parents: *eyeroll* "No. And we don't need to either."
Me: "Umm. . okay. Well I know he can't speak for himself right now. But what do you think would be his preference?"
Parents: "Well. Seeing as he has no insurance and not much else? I hope his preference would be to go with whatever is best for him."
Me: *silence*

Damn.
Damn damn damn.

There was drama later. Major drama. Those hushed voices began to escalate. In the hallway. In the room. Near the elevator. And probably some other places that I don't even know about. But it was sticky and yucky and contentious and just. . .yeah. I did my best to stay out of it. But it isn't as easy to do that as it sounds.

Sigh.

*steps onto soapbox*

Look here, man:

Everything--and I do mean EVERYTHING--is about relationships. Working at them. Clarifying them. Solidifying them. And, when possible, taking necessary actions to seal them as legal.

For real.

Those almost in-laws you don't mess with? That estranged spouse that "might as well be divorced" from someone? Those siblings with whom you're at war? That parent that you don't talk to at all anymore over some kind of petty disagreement or even some major disagreement? Look man. I implore you to do whatever it takes to get on the other side of that complicated.

Yep.

If you fall ill and can't speak for yourself? Guess who gets to call the shots? Your legal power of attorney. Married? Your spouse. Not married but without a power of attorney? Your parents. Or your siblings. Would you be cool with the person who would legally get to be the shot-caller for you as of this very moment doing so? If not, I suggest you do something about it. Stat.

And even if you DO have the legal parts all copasetic and such? Still work at the relationships. Because if illness falls, it WILL call for y'all to interact. A lot. Grown siblings. Grown grandkids. Long-term boo-thangs. Those folks want to have a say. And even if you make up your mind that they can't have one, you might lose a few years of your life through angst and worry just trying to stiff-arm the ones who want a seat at the table.

Yup.

The good news is that I see lots of long term partners who navigate life-threatening illnesses well with families. But that is always when it is anchored in some kind of respectful understanding of their position. With this patient? That wasn't the case.

And that? That sucks, man.

*steps off of soapbox*

Come together. Right now.

Or else.

***