Stronghold.

Giving up 
is so hard to do
I said I've tried
But it just ain't no use

But my light of hope 

is burning dim

But

But in my heart I pray
That my love and faith in the girl
will bring her back someday

~ from Donny Hathaway "Giving Up."

"Sit down on that chair, hear? What did I say?"

This sixty-something year old woman furrowed her brow and pointed her finger sternly at the two toddlers fidgeting in the chair beside the examining table. A little boy and a little girl -- certainly no older than three and clearly a big handful.

"Gran'mama, I'm hungry!" the little boy whined.

She didn't say anything in response. Instead she reached into her pocketbook and pulled out a little box of animal crackers and opened it up. Next she whipped out a little package of travel tissues and quickly secured one tissue in each hand. Holding both up to each child's nose simultaneously she directed them. "Blow."

*phhhhhttttttthhhhh*

Those little toddlers did just as they were instructed. This grandmama meant business.

I had just stepped into the clinic room with one of the residents when I caught all of this. And honestly? It wasn't exactly unusual to see a patient with children in tow. I kept things light and made a little small talk.

"Hey there, Ms. Ashton. I think we may have met before -- I'm Dr. Manning and I work with your resident doctor." I reached out hand shook her hand even though she'd just had a snot-filled Kleenex in it. "I see you have your grands with you today, huh?"

She made and exaggerated eye roll. "Honey, I got my grands with me every day--y'all stop dropping' all them crumbs all over the place, hear?" The obedient toddlers shifted nervously in that shared seat.

"Are they twins?" I asked. Partly because I was still making small talk but also because I was just curious.

"Mmmm hmmm, chile. And they a handful, too. Sweet little babies, but they a handful for sure. Cain't you tell?"

We all laughed, the resident, Ms. Ashton and me.

"You keep your grandbabies during the day?" I chuckled and reached out for the little girl's hand. It warmed my heart when she let me.

Ms. Ashton grabbed the box of animal crackers and dusted the crumbs off of their laps with her other hand. Her wide hips shook as she swished her hand and caught crumbs into the box. She returned to her chair and let out a sigh. "I keep my grands all the time. They stay with me 'cause my daughter cain't take care of 'em herself."

I widened my eyes and prepared to back off. I cast a quick glance in the direction of my resident because none of this had come up when she'd presented the patient to me. The look on her face suggested that this was news to her, too. I suppose she'd simply assumed that a kind grandmother was watching two of her grandchildren.

"Her mama got a stronghold. Hooked on that crack mess. So the state was gon' take her babies but I said, 'Naw, we don't do that in this family.'"

"Stronghold." Sure, Merriam-Webster has its own meaning for this word, but coming from a Grady elder, I knew exactly what this meant. A stronghold. The term the elders use to describe an addiction or gripping weakness; usually referring to how powerless it renders its victim.

I remembered that woman today. I remembered her not because of the medical problems we treated her for that day but because of our very brief conversation about her daughter. She went on to say a few words about her daughter and her addiction--always referring to it as a "stronghold."

"It's out of your hands. That's the thing about a stronghold. All you can do is love 'em and pray. Getting' mad at 'em don't help nothin'. So you jest love 'em and pray. Other than that it ain't much you can do."

***

This past weekend we went to visit some of our closest friends, Shannon and Michelle, in Virginia. The weekend was full of joy and laughter and memories and all of the things that time with old friends affords. Saturday was full of celebration. Their youngest child, Colin, turned five and we spent the day swirling in kid-centered fun. The night involved sugar-hyped children and dance games on Wii consoles. Wonderfully trapped in the basement where no one could get into much of anything. Which for us grownups meant clinking wine glasses and adult conversations. It was the very best kind of time.

At some point after a few too many laughs and after the Pinot Grigio had just about worn off, a couple of us wild and crazy kids decided that nothing would better than some Dunkin Donuts coffee for the after party. So my friend Nikki G. (who was one of the only ones who'd passed on the Pinot) agreed to drive and off the two of us went on an 8 PM coffee run. On a Saturday night. Which, okay, now that I think of it, sounds like a very lame and forty-and-up thing to do.

But I digress.

Anyways. Here we are all loquacious and happy like some twenty-somethings who are just leaving the club. LOL-ing and OMG-ing. And full of life and vigor and joy as we danced our way into that empty Dunkin Donuts. And, yes, it was totally empty because, as it turns out, America might run on Dunkin but Dunkin Donuts is not EVEN the hot-spot on a Saturday night. At least in Alexandria, Virginia it isn't.

But for me, it was the place to be because I felt light and free and relaxed. My kids were having a great time with great friends in a safe place around people I trust. And at the very same time, Harry and I were, too. The older you get, the more you appreciate these moments. Yes, you do.

So yeah, Nikki and I bust into the spot all giddy and goofy--her just because and me because I'm out of town/away from work/and okay, perhaps with some remnants of Pinot Grigio--and it was a perfect moment. It truly was. I even had on Zachary's Paul Frank monkey hat which made us laugh even more. And that made it just that much more perfect.

"Dude! Since when do they have plasma TVs up in Dunkin Donuts!" I joked. Still laughing and giddy. With my monkey hat on.

But then, just as Nikki prepared to counter my observation, we look up at that screen and see this:

And just like that we stopped laughing. Both frozen in our tracks, staring at this literally sobering news. Because we both knew that this was one of those "where were you" moments. So we just stood there in silence for a few seconds letting it sink in. 

Whitney Houston Dead at 48.

"NO WAY!" I immediately yelled out. 

"WHAT!?" Nikki screeched a mere two seconds later.

CNN. That's reputable. Wait, huh? Whitney? Whitney Houston? Our Whitney? Dead? According to CNN? 

"NO WAY!" 

"WHAT?!" 

And then we just paced back and forth, looking at the flatscreen television and repeating those same words over and over again.  NO WAY! WHAT?!

Then I turned my shock toward the poor, unsuspecting South Asian man behind the counter. "WHAT HAPPENED TO WHITNEY? WHAT DID THEY SAY HAPPENED TO WHITNEY!?" 

And yes. I meant to put it in all caps because I was speaking loudly and was probably being a close-talker to boot. Hearing that Ms. Whitney Houston was no longer alive was disorienting. So much so that I decided that Mr. Dunkin had some kind of hot off the presses information that we hadn't yet learned. I mean, seeing as he is up in there with that flatscreen on CNN all day. 

"YO! What they say happened to Whitney?!" I demanded again. And yes, I meant to write "what they say happened" because honestly? This is exactly what I said. I mean, somebody had just said that Whitney Houston had died. This was no time for standard English.

where I was when I heard

So Mr. Dunkin just shrugged in this weird way that looked partly like he had no idea what I was talking about and partly like he was deeply afraid that this was about to be a stick-up. I believe that my interpretation of that shrug is spot on. 

So we go from pacing to just standing there with our arms folded shaking our heads. Then we both get tearful for a moment as the same images keep showing over and over and over again.

Whitney is dead. No, wait. Whitney Houston--our Whitney Houston--is dead.

That's when that word popped into my head:

"Stronghold."

So apropos, that word. I thought of Whitney Houston's mother, Sissy. I imagined her daughter, Bobbie Christina. I even thought of Oprah Winfrey applauding her big comeback and punctuating it with a two-part episode in her final season. 

Stronghold.

I thought of every single woman who has ever sang a song or wanted to have a big and unforgettable voice and how by definition she had to look up to Whitney Houston. Because regardless of her struggles, her voice was unmatched. 

That voice made her very rich and very famous. But despite her talent and fame and fortune, she wasn't immune to that stronghold. And just like Ms. Ashton said that day, it was nothing her family could do. Hell, it was even too big for Oprah Winfrey herself to love her through. 

Ms. Ashton spoke a good word that day between passing snacks and wiping noses:

"It's out of your hands. That's the thing about a stronghold. All you can do is love 'em and pray. Getting' mad at 'em don't help nothin'. So you jest love 'em and pray. Other than that it ain't much you can do." 

Ain't that the truth.

So today I'm reflecting on Whitney Houston--our Whitney Houston-- and her stronghold. I'm also reflecting on Sissy Houston and Bobbie Christina Brown and every single Sissy and Bobbie who have ever had to stand by helplessly in plain view of their loved one being strangled by some kind of stronghold. 

Because the worst part about it is that it's out of your hands.

A lot of us were disappointed in Whitney. I guess we thought that with a voice like that, that she was superhuman and supposed to do more with her legacy. Seeing her erratic behavior was so hurtful yet we still loved her and accepted this version of her. That's the thing about a stronghold. 

Yes, we loved her and saw her as a golden girl. We wanted a scapegoat  so we even blamed Bobby Brown for a while, but over time it became apparent that she was ill. And even if Bobby sat next to her acting quirky and high on Barbra Walters' show, he still had his own stronghold. And Whitney's belonged to her. 

No, I don't know the specifics of Whitney Houston's cause of death. But I have lived long enough and worked at Grady long enough to know that even if it wasn't specifically related to drugs, it still was. We had waved good bye to the old version of her some years ago. That lanky, confident songstress with the poise of an opera singer and had forced ourselves to get used to this new person in her place. That's the thing about a stronghold. It's like watching a slow death. . . . even before someone dies.

I have seen people escape strongholds. Very few--but I still have. 

I've seen Ms. Ashton a few more times since that first meeting. Every time those grand babies are in tow. And most of the time, we've moved on and chatted about mundane things as if her lost daughter was just "one of those things" that you know of but tried not to think of. But you quietly promise in your heart to pray about it because the love is the part you can't forget.  Even when they're gone. 

Kind of like we did with Whitney all those years.

That's the thing about a stronghold. We hold on, too.

***

Now playing on my mental iPod. . . . "Giving Up" by Donny Hathaway. . . .the song that always reminds me of strongholds -- and especially the people loving someone through one. His haunting voice and the musical accompaniment seems like it was recorded for this very moment, I swear. Please. . .please listen to this one,okay? Thanks.

Heavy.

"So on we go
His welfare is my concern
No burden is he to bear
We'll get there
For I know he will not encumber me
He ain't heavy, he's my brother"

~ Donny Hathaway

Today I am thinking about trust. I am thinking about how although folks often talk about how little some people trust their doctors-- that there are a lot of folks that put a whole, whole bunch of trust in their doctors. And not just any kind of trust, but that save your life kind of trust.  Like, I know you've got my back no matter what kind of trust.

Compound that with being a black woman on the front lines of a county hospital and it gets even more complex. Like, you get me so you know deep down what I'm afraid of kind of trust. Like, I know you wouldn't let nothing happen to me on your watch kind of trust. 'Cause you get me. 'Cause I'm your auntie and your uncle and your sister and your granddaddy. 'Cause I'm your mama'nem and your Mudear and your play cousin. And sometimes, it's heavy.  Real heavy.

'Cause even though they are thinking those things, they aren't alone. I am, too.  I am thinking, you can trust me. I am touching your hand and using your language in a way that says, I do get you and I do know what you are afraid of deep down. And even though sometimes it's unrealistic, I am feeling, no, I won't let nothing happen to you on my watch. Even if it's out of my control.

So I pray. A lot. To fill in the gaps that reading journals and calling consults can't cover.

And today? After all of that, I stood in a bathroom stall and cried. Because a lot of times it is out of my control. And sometimes things do happen. Even on my watch. And today, it was heavy.  Real heavy.

So thankful I'm being carried, too.

***

"If I'm laden at all
I'm laden with sadness
That everyone's heart
Is not filled with gladness
Of love for one another. . ."

Dad, do you remember when you played this Donny Hathaway song for me when you drove me to medical school across the country? I know you don't. But I do. Especially today, I do. . . . playing on my mental iPod. . . listen and you'll feel me.

 

Reflections from the day before the first day of Black History Month: Young, Gifted and Black

My sons: young, gifted and black

"Play" - Jacob Lawrence (1970 - 2000)

To be young, gifted, and black
Oh what a lovely precious dream
To be young, gifted, and black
Open your heart to what I mean
Cause you know
In the whole wide world
There's a million, a million boys and girls
Who are young, gifted, and black...
and thats sho'nuff where its at. . . .

"Young, Gifted and Black" by Donny Hathaway (1945 -1979)

______________________________________________________________
Thursday, January 27, 2010

I slid into our weekly Division lunch meeting a few minutes late after finally breaking away from the residents' clinic in the Grady Primary Care Center. I was still shaking off the arctic blast that had hit me when I'd crossed the street from the hospital into our faculty office building where the meeting was held. Every Thursday, this is the place where all members of our Grady General Medicine faculty come together. . . . .sometimes just to discuss business, but most times to get an update on what a colleague is doing or to hear an expert share some new development that will affect us Grady doctors. It's a great place to learn, but also a great place for building an esprit de corps amongst our faculty.

This week the speaker was, much to my delight, my friend, David M. Yay! I settled down into my chair after grabbing a plate from the catered lunch and shot him a wink. David and I joined the Grady faculty the same year, and became fast friends. Upon our first meeting, we laughed out loud for nearly an hour. Both black Americans (unapologetically so) and both pretty darn animated, David and I are kindred spirits in every sense of the word. He is, hands down, one of my favorite people. Our friendship is respectful and meaningful, and because of this our professional relationship has evolved into this reciprocal cheering section. We are constantly pumping each other up for even the smallest accomplishments, and --oh my gosh!--don't let one of us have a big achievement. We miss no opportunity to effusively describe one another to any resident, medical student, acquaintance or even rock that will listen--but most of all, we make every effort to embarrass each other every chance we get, kind of like a proud grandmama does.

Case in point:

David: "I'm just trying to be like you when I grow up! I saw your publication in Annals! Mama, you better DO it!"

Me, quick on the response: "I'm saying, David! All I want to know is which one of us was interviewed by Peter Jennings on World News Tonight before he passed away? I mean seriously, David? Peter Jennings? That's all I'm saying. "

David: "But I need to know, who got two big ol' teaching awards in the same year all while wearing 3 inch stilettos and carrying a Gucci bag? Oh, and while handling her business as a wife and a mama of two little bitty kids! This is what I'm saying!"

Me: "But work with me, D! Those were local awards, and I appreciate the shout out, I do. But help a sista out--weren't you the dude on the President's Advisory Council? No, like the President of the United States, not Emory? The President, David? Seriously? I mean come on, dude. I'm just saying -- what do you do, shoot him a text message when you have something to tell him?"

Eventually we erupt into a hearty laughter, hug, and leave feeling encouraged. It's good to have my kindred spirit rooting for me, and it's great to be able to return the favor. So there I sat, pom poms ready. I was glad that he would be teaching this day.

He stood boldly at the podium, discussing with the division slide by slide his exciting research project. "I'm exploring the psychosocial and mental health components that lead black men to behaviors that may put them at risk for HIV. So much focus is in the U.S. is placed on brothers who identify as homosexual; it makes no sense that we're ignoring this huge population of heterosexual brothers," David said in his melodic voice. I dug the way he was confident enough to say "brothers" in front of our division. It was so David of him.

After marching us through his plans for his study (funded by the huge R01 NIH grant he just won), he was met with warm applause and accolades from members of our group. His eloquent answers to their questions rolled off of his tongue like raindrops dancing from a rooftop; everyone sat at rapt attention. You better do it, Dave! I felt proud as I watched him. . . . dynamic. . young. . .gifted. . .black. I internally waved my pom poms.

"He's so articulate," some person might say, or "My, how well-spoken he is!" another might add-- not realizing how offensive that can be to the countless numbers of well-educated men like David who receive such a compliment.  

(Cultural Competency Sidebar: Most folks who graduate from Princeton like David M.--or from anywhere for that matter-- usually have a pretty good mastery of the English language, regardless of race. I'm just saying. . . . . for future reference to anyone who might inadvertently say such a thing to or about a black man.)

David M., black history in the making

dope (adj.): cool, nice, awesome (courtesy of urban dictionary)

In defense of the person who does remark on his speaking ability, it is definitely fair to say this: David M. is an amazing public speaker and his presence is rather remarkable. Here is this young Haitian-American man who has dedicated his entire career to researching factors contributing to the HIV epidemic in black men (a pretty courageously narrow area of focus)--and not only that--he's an authentic guy in every way. Dave is transparent about his preference for men as intimate partners but is equally transparent about his refusal to allow himself or patients like him to be placed in boxes of any kind. He's what my friend Tracey H. would call "dope." As I watched him teaching and answering questions, I found myself wondering, What makes a young man so okay with himself and so convinced that his voice is worth listening to? What makes him so. . . well. . ."dope?" I stuck a post-it note on the bulletin board in my head reminding myself to explore that with David at some point. As a mother of sons, I'm always interested in what makes a manchild feel whole when he grows up.

The following day, David and I walked down the street to the Sweet Auburn Market for a quick lunch, and I knew I'd get my chance to pick his brain. Amidst the chaotic lunch crowd made up of mostly Grady employees and patients, I launched into my exploration of what made my friend tick. "Dude. . . .how did you get here? I mean, like this? How did you become so okay with you, you know? It's really something to see, David. You're so comfortable in your skin. It's like. . .what every parent ultimately wants for their child. . .to be confident, fulfilled, and fearless." 

In other words, how'd you get so dope?


He chuckled at the question, and started with his thoughtful answer. He talked about several things--his parents, life experiences, and role models. Mostly general stuff. I guess it all made sense. I suppose I was waiting for some pivotal experience to be pulled out of his pocket and slammed down on the Formica lunch table in front of us. Instead, it was nice, but a lot less dramatic than I'd expected. I wanted to know who the linchpin was or what thing was the piece de resistance that made him throw his shoulders back and stand just a little bit taller.

"A lot of things,"David said while breaking off a piece of salmon croquet. For now, that would have to do. The conversation then went to our usual topics. . . . friends, work, home, news, family, patients. We finally found ourselves talking about a recent experience David had on the wards.

"There was this young brother I was caring for in my clinic that had been having diarrhea for several weeks. He had been seen in three different emergency departments and was even admitted once. He called me and said,'I just don't feel right. Everywhere I go, they keep saying nothing is wrong with me.' Wait, did I already tell you this?" I shook my head 'no'. It wasn't unusual for us to accidentally retell stories to one another. Depending on the time and the length of the story, sometimes it was worthwhile to just hear it again. But this was not a story I'd heard. I sat there quietly nudging him to go on. "He has really low T-cells, so I mean, he really could have had something going on, you know? Since he's my patient at the Ponce Clinic (Grady's outpatient center devoted to care of patients with HIV/AIDS) I made an executive decision to directly admit him to my team. When we ran through his labs, it turns out we found a positive stool study--totally explaining why he felt so bad. Nobody had believed his symptoms. He was so relieved to find out there was an explanation."

"Nobody but you," I replied. "Wow. It's a good thing he had you as his doctor."

"Yeah. . . "David said softly with a distant gaze. Suddenly he grew surprisingly quiet. He shrugged his shoulders and added, "He just needed somebody to believe him. Sometimes you just need somebody to believe you . . . .and believe in you."

"Hmmm," I murmured while nodding. I narrowed my eyes and took in what he was saying.

"As time goes by, I'm starting to see that this is part of why I am in this position, you know? To believe in my patients." David cleared his throat and then took a bite of his lunch to break up what seemed to be mounting emotion. Hmmmmm.

If you understood David's panel of patients, predominantly all black males with advanced AIDS and many of whom have had male sexual partners, you'd realize how powerful that statement could be. You take a patient from an economically disadvantaged setting, blend it with being of a historically oppressed race, and complicate it with a poorly understood and often poorly accepted lifestyle--oh yeah, and if that isn't enough, you throw in AIDS, too. It's probably hard to have somebody believing in you or much else your concerns when you fall under that umbrella.

As I sat across from David in the market that afternoon, a fleeting thought of a young, Jamaican transgendered patient that I once referred to him crossed my mind. He was new to the area, had just been diagnosed with AIDS and was totally terrified. "I have the perfect doctor who will take excellent care of you," I remember saying as I referred him to David. My confidence in David seemed to allay some of his fears. That patient needed someone to believe in him, too, and that is exactly what David did.

"That's a pretty awesome statement," I responded while staring into his now glassy eyes. I wondered where all the emotion was coming from. Hmmmmm. "It sounds like you're walking in your purpose, David. Somebody must have really believed in you for you to be able to do what you do for your patients."

David clenched his jaw and swallowed hard. "My father," his voice trailed off for a minute and then came back," My father always. . . . he has just always--" he interrupted the statement with a sigh--"he has just . . . there have been times when no one believed me. . . . and. . . .he. .he did." He stopped talking for a moment and just looked straight ahead. I decided not to nudge him much further 1, because we were sitting in the Sweet Auburn Market surrounded by Grady people, and 2, the last two times I heard a brother trying to talk about how much he loved or appreciated his father, it got real, real ugly. . .and involved some breaking down and crying -- real hard. I decided to ride it out for at least a minute or two.

We sat there quietly for a few moments, both just thinking. Then came the ah hah moment. You are giving to them a piece of what your father gave you. Aaah hah. I broke the silence and said, "So that's it. That's why you're so dope." We both laughed. I smiled and thought of the picture of his Haitian father that sat lovingly on the shelf in his office. "That's why you're so okay with yourself and your voice. Now I get it."

He sighed again and offered me a wistful smile. I could tell he was still thinking about his father. "Yeah," he managed to eek out. "Yeah."

***

So today, I am reflecting on the powerful testimony our lives become when someone believes us. . . and believes in us. Belief gives us wings to fly. It gives a scared patient the courage to get the care they deserve, it gives a medical student the confidence to step boldly into that same patient's room to participate in their care, and it even gives a same gender-loving black man from upstate New York his voice. . . . . .his audacious, intrepid, fiery, and unapologetic voice. Somebody's belief turned a mirror on him and convinced him that being his authentic self was perfectly acceptable. And regardless of what anyone else thinks about the details--I think it's a good thing to be alright with yourself.

Like I told David--now, I get it. Being loved, cherished, and believed helps us to get as close as we can to being whole. But most of all, it helps us to believe in ourselves enough to pay it forward to someone else. And at the end of the day, that's sho' nuff where it's at. :)

My daddy played this song by Donny Hathaway for me on his car stereo when I was a just little girl, and I will never, ever forget it. I still remember him shaking his head to the haunting melody with his eyes closed, and telling me to "listen to the words and to believe them." This song really symbolizes how hard my parents worked to make me believe in myself, how they fought to never let any self-hatred set in, and explains a lot about why I am the way I am. When I hear it, it transforms me into a seven-year-old again and still makes me so proud of who I am, that I cry.

Today, at the threshold of Black History Month, I am playing this song for David M. . . . . for my own sons . . . . and for all of our young, gifted and black Grady patients who may never hear these words anywhere else.