See one. Teach one.

I snapped this picture with my iPhone on rounds last month. That's Elicia S., an awesome fourth year medical student, standing there explaining a complicated plan to our patient. I was so proud of her and how much command she had of the room and what she was doing.  I also love the way our newly minted second-almost-third year student, Yasmin A., was watching her.

Sigh.

This? This is medical education at its finest. At the bedside. As a team. Learning and caring and explaining and growing. This image embodies how our team rolled last month. Time and energy went into building our students' and interns' confidence in talking to the patients more than talking to anyone else. The patients. Not just me, the attending. The patients. 

Explain what's wrong. Answer their questions. Feel a little "put on the spot." It's okay, though, because we are all at the bedside with you. And we are all in this thing together. You're damn right we are.

I was just hiding in the shadows observing that day. It was the last day on service for me and now the learners were in an amazing groove. And Elicia. Look at her standing all tall. Can't you just see the respect she is showing for that patient? And look at Yasmin. Watching. Learning. Growing right along with her. And man my chest was all poked out like a mama bird or better yet what my dear friend the profesora in Pittsburgh calls the "mama gallina." So I lifted my phone and covertly snapped this shot--one that wouldn't include our patient, of course, but would capture what I was seeing.

Because what I was seeing was awesome.

Bwwawwwk. Bwawwk. (Pardon me, that's just me having a mama gallina moment.)

And this? This is medical education at its finest. Yes, it is.

There's this old saying in medicine that goes "See one. Do one. Teach one." But you know? I'm thinking that maybe we need to focus less on the "do one" part and more on the other two. I looked at this picture over and over again last night while working on a campaign for our Academy of Medical Educators.

See one. Teach one. 

That was the thought that immediately popped into my head. If you see one, teach one. Period.

That goes for everyone. Patients. Students. Colleagues. Everyone. Pay attention. Watch someone teach and learn something. Listen to the patients and learn something. No matter how old you are or young they are. Or vice versa. It's all just a reminder to never miss an opportunity to teach the ones you see. All of them, even if it's something tiny like "that Ivory soap is actually making your skin drier" -- that's better than nothing.

So that's why this tzujj-ed up iPhone snapshot is one of the centerpieces of our Academy of Medical Educators. Because of what it captures. It captures the best of what we should be doing as medical educators. Yes, it does.

And no. We don't always get it right. I am the first to admit that. But sometimes? We do. We so do.

See one. Teach one. 

Man. If we can just master those two, seems like do one will take care of itself. Don't you think?

Yeah.

***
Happy Tuesday.

White coats and questions.

*story shared with permission.

On Saturday, our first year medical students received their very first "white coats" in a symbolic program called "The White Coat Ceremony."  Family and friends came from near and far to witness the event--okay and maybe. . .just maybe. . .to lay eyes on their children and see where all of their money is going.

The day was beautiful. It was so lovely that I tossed my high-heels into my purse and walked to campus that afternoon with a pair of flip-flops. It was as if God himself smiled on the day and decided to make the sky just a little bit bluer and the grass just a little bit greener.  Yes. That day was in technicolor.  But more spectacular than those colors was the energy.  I don't even know how to describe it.

I met so many special people.  I loved the proud twinkle in the parents' eyes when I introduced myself to them. Kind of like meeting one of their children's professors sealed the deal. Yes, my baby is in medical school and my baby is going to be a doctor.  I guess that is something to be proud of, huh?

Well. The entire day was my favorite day. It started casual with soccer and folding chairs and water bottles.  That part was awesome. Then all of that soccer-awesome seamlessly changed over to all of this white-coat-awesome. I realized after seeing all those parents beaming with pride that all the proud-mama-ness that I feel during soccer is really just the beginning. Wow.

half soccer-mom/half amazing

Anyways. It was a special day. But. If I had to pick the very best moment of it all, though, it would have to be this:

After the ceremony we all walked around greeting the families and hugging our newly minted "M.D. candidates."  Some I'd heard about, some had heard about me, and most times a little of both.  There is this one student who shared a week with my team on the wards during the first days of school. The experience was rich and brimming with teachable moments, and he, along with one of his other first-year classmates, drank in every drop.

Unfortunately, there was one part of that week that was bittersweet for him.  His beloved grandfather, who happened to be an Emory School of Medicine alumnus, was nearing his final days.  He was candid in sharing this with me, and of course, I understood his need to abbreviate the week to return home. The day after I learned of this situation, I was surprised to see him on the wards.

"What are you doing here?" I asked him incredulously.

"I decided not to leave yet. I'm going to play it by ear," he said. "I want to stay a little longer."

Play it by who? Say what?

I was really troubled by all of this, quite honestly.  I wanted to send a message to him and the other team members that family is always first.  I needed him not to be heroic by rounding with me at Grady instead of being with his granddad.  But he was firm in his resolve. This student had clearly given all of this careful thought--it was what he wanted to do. I respected his decision.

At the end of that week, I sat the students down to debrief what they'd seen. We discussed their experiences and explored how it made them feel about medicine.  Then I asked about my student's grandfather.  "How is he doing?"

"I will be heading home shortly," he softly replied. "Mom says he's not doing so well. It's getting close."

"Did he know that you were going to be starting medical school at Emory?" I had to know.

"He did."

We all sat in silent deference.  He broke the hush by saying these words. "You know. .  . my grandfather. . .when he heard I was going to be starting med school he said to me, 'When you get there, go off by yourself and just walk around. Look around and ask yourself if this is really what you want to do.'"

I kept my eyes fixed on his and probed. "Did you? Did you do that?"

He nodded quietly.

"What did you decide?"

"Yes. This is what I want to do," he spoke firmly while still holding my gaze.  Then he looked around the room and continued. "My grandfather did his internship right here at Grady Hospital. He and my grandmother lived right up the street from Emory, too.  You know. . . it's almost like I could feel him with me this week. Like. . . like he was there, you know?"

My eyes welled up with tears as his simple truth rang like a tiny bell in my ear.  I cleared my throat of the mounting emotion and said, "So your decision to stay---" I pressed my lips together to keep from crying "--was a decision to be with your grandfather after all."

He smiled bravely and sighed.

Ah hah. Your decision to stay was a decision to stay. Ah hah.

And there we sat. Taking in the magnitude of that moment and what it meant to him to be at Grady Hospital. And now, what his presence for those days meant to all of us.  I tried to imagine his grandfather as an inquisitive medical intern at Grady, scuttling through the halls with hospital whites on. Wow. I felt honored to be the steward of his grandson's experience that week.

"Dr. Manning? This is my grandmother."

This is what I heard that student say to me after the ceremony on Saturday. I faced him in his pristine white coat, filled with the promise of a young doctor's future. Surely that very promise his grandfather held some four decades before. Then I turned and rested my eyes on his grandmother.

I took the hands of this elegant matriarch and took in the complex mixture of pride and sadness in her eyes.  She was beautiful, both physically and spiritually, and I was so glad she was there.

"I am so, so honored to meet you," I emphatically told her.  I meant that because that is truly how I felt.  I knew that after losing her beloved just one month before and taking in the sights and smells of a place she shared with him was hard. But she was there. Strong, resilient, grief-stricken--and there. This was a big deal.

She offered me a smile so tender, I thought I'd cry right then and there.  I composed myself and told her what her grandson had done. "Your grandson brought your husband's legacy to life for us. He honored him by sharing his lessons and mostly by sharing his story.  He also told me all about you.  You know this already but you have a very special grandson."

We instinctively hugged, and it was right.  A knowing hug filled with mutual gratitude for the continuum of life as we know it.  "He is in good hands," I whispered to her.  "And so are we."

She nodded and hugged me once more. And yes, it was still right.

That was just one moment. But do you know there were several others that closely mirrored this? Like for every student there was an intricate tapestry of family and love and sacrifice trailing behind them. I loved seeing it, and just like those students during that first week on the wards, I took in every single drop.


When I walked home, I thought of that encounter with the elegant matriarch repeatedly.  I took in the neighborhood and imagined what it must have been like when she'd walked this very thoroughfare many years before.  Man. I sat on a bench and took a moment to reflect on what this all meant. Me telling this woman that her grandson was "in good hands." Us knighting our students with white coats. The charge we have as stewards, really, of someone's professional upbringing.

Wow. This is a lot.

For the rest of that walk, I took that sage advice and asked myself that question. "Is this what you really want to do?"

Yes.

***
Happy Monday.

Pomp and circumstance.

My small group graduated today. All but one (who is pursuing a dual degree) walked across the stage where I joined the Dean in hooding them as medical doctors. Them. They graduated.

Yes, definitely.

I've had the fortune of growing close to and being touched by many students in this class, not just my advisees. But the thing is . . . . with my small group . . . . .meeting with them just sort of got hardwired into my life over these past four years in that way that picking your kids up from school or brushing your teeth does. Important, yes. . . .yet so every day that it seems like it will always be that way.

Somebody said this: "The days are long but the years are short."

Ain't that the truth.

Yeah, man. I'm still looking for the words that I want to say about this day. Right now, they are in big cartoon-looking clouds over my head, but not yet in paragraphs. Those clouds include words like "proud" and "moving" and "honored." Then I get choked up and stop there. Because seeing them graduate was a lot. It was a whole lot.

I am happiest because they did it. I am saddest because I will miss seeing them. I am proudest because I was there. And not just there. I was really there.

Okay. Whew.

I'm going to stop here. Will write more when I get the words together. Maybe. For now, I hope pictures are okay.

More people who were there who know how I feel.

Me? I was there. Oh, and if this medical school seems awesome?
That's because it is.

Small Group Alpha - EUSOM Class of 2011 from Kimberly Manning on Vimeo.

***
Congratulations, doctors. And welcome. We've been waiting for you.

Reflection of a Clinican-educator on a Tuesday: Reasons, Seasons, and Lifetimes

with my "small goup" advisees at the AIDS Walk 2008. . .
. . then as second year students. . .soon to be 4th years. . .

With my former fourth year student, Bianca S. at Commencement 2010

_________________________________________

Nothing is here to stay

Everything has to begin and end

A ship in a bottle won't sail

All we can do is dream that the wind

will blow us across the water . . . .

A ship in a bottle set sail.

from "Baby" by Dave Matthews

___________________________________________________________

May and June mark the end of our academic year in medical education. The medical students either advance to the next level or become sho' nuff and bona fide doctors--albeit uncertified and untrained--but doctors nonetheless. The interns exit the novice stage and become residents; one week asking someone senior what to do, the next telling someone junior what to do. And of course, the senior residents and fellows finally get the stamp of approval that officially releases them from the nest. It's kind of bittersweet for folks like me--the surrogate mommies and daddies that helped guide them along this path to becoming full-fledged physicians. (Though I'm sure it comes as no surprise to you) I must admit that this time of year, I get just a wee-bit choked up. (Don't worry--it's usually not the ugly cry.)

with my former fourth year student, Olivier D., at Commencement 2010

Right now we are doing the whole "graduation" thing. Farewells to so many. . . our chief residents, our senior residents, and even the interns that spent this first year training in Internal Medicine as Transitional Year interns--all of whom will now flutter away to their chosen career paths. At risk of sounding cliche, I'll say it anyway: "Seems like only yesterday that y'all were deer in headlights asking me your cute little questions in orientation." Sigh.

with Shannon H. and Annie G., transitional interns 2009 - 2010
. . .Radiologists 2010 and beyond

What used to make these transitions so hard for me is the nature of time. With time, some of the most seemingly memorable people can fade into fuzzy blurs. . . .reduced completely to, snap your finger! snap your finger! "What was that guy's name? Uggghh! It's going to bother me all day! You know who I'm talking about! That guy with the sandy brown hair and freckles that went into Cardiology!" That guy took call with you every third night in the ICU and ordered Chinese and Mediterranean and Italian takeout with you. That guy told you that your inconsiderate boyfriend who made you cry between admissions was missing out and that it was his loss. That girl wrote you the nicest card at the end of the year, and even invited you to her wedding. Oh, and that student you worked with? She was the one you vowed to stay in contact with forever. What happened?

with my former advisees Shveta R. and Dorothy W. on Match Day 2007

A few months ago, I was at the ACP meeting in Toronto and saw this gentleman standing in the conference hall from a distance. I knew I knew him from residency training, or was it an away rotation during my 4th year of medical school? Hmmm. Maybe he trained at Emory? I know he was on a team with me at some point. But his name? No where near the tip of my tongue. I squinted my eyes and remembered that he was very nice. . . Lebanese, maybe. . . . .a great doctor. . . .and exceptionally smart. But despite my best efforts, I could not, for the life of me, place his name or his place in the time line of my medical life. It bothered me because I knew that we'd worked closely at some point, and that, whenever or wherever it was, I'd spent a lot of time with him. How could I not remember exactly who he was? Does it mean that I am a loser? Gosh, I sure hope not.

So here's the thing: Life happens. People move and people move on. Those every day surroundings fade into remote memories right along with some of the most every day people. What does that mean? Does it mean that those things were somehow less important? Does it mean that we have allowed ourselves to become so busy with our business, and fussy with our fussiness that we've neglected to preserve the flowers that we used to smell every single day? Naaah. It's not that simple. The older you get, the more you realize that there's more to it than that.

with former Grady doctors, Ben A. and Cherry L. (and their ninos) 2009

"People come into your life for a reason, a season, or a lifetime.

When you figure out which it is,
you know exactly what to do for each person."

~ Aleksandra Lachut

My mother shared this quote with me the day before I got married. She elaborated on the importance of all three, and how fortunate those who can discern such a thing are when meeting people along life's path. I've decided that this applies to the relationships fostered in medicine, too. There are some students and residents that I can close my eyes and see, hear, and bring to life with virtually no effort. Then there are classmates from medical school that I could not name if my life depended upon it.

As I pondered this more, I also thought about the people that I've had only fleeting contact with professionally--who somehow clicked with me and became "keepers." Like my friend Kris R. who worked with me at Grady for, like five seconds, but who, upon first meeting, was an automatic keeper. The instant friend that was only passing through but whose friendship felt exactly like worn-in slippers from the start, and who made me laugh so hard over dinner last week that I thought I would be sick. Or like my friend and fellow Grady doctor, Lesley M. who almost never shares the same clinic schedule or ward schedule or schedule period with me, but who seamlessly maintains "lifetime" status as one of the people I most look forward to seeing at work. Now I understand that some people have an impact on you for a reason. . . or only for a season . . .or, if you're lucky, a lifetime. And that the quantity of time they spend with you, or even the quality alone for that matter, is not quite what determines where they will fall in this line up. It seems to just sort of happen on some higher plane that can't be forced or explained.

I won't take it personally if a student, a resident, or a colleague doesn't remember me in high definition. It's okay because I know that some will. And despite their best efforts, I know that the others will eventually recall me only as, snap your finger! snap your finger! "You know! That black female attending that wore the short haircut that wrote the touchy-feely blog! You know who I'm talking about!" Yep. It's hard to imagine. . .but it's a reality that just is. And you know what? I'm okay with that.

After 'while. . . . . crocodile?

So yeah. . . . .I'm waving goodbye to some, saying "see you later" to others, and preparing to usher in a whole new complement of students, interns and colleagues. Through it all, I'll be silently sorting each of these special people into reason, season, or lifetime. Who knows? Some may fall into all of the above. In doing this,especially during these periods of transition, I think the "thank you for everythings" will feel more authentic, and the "you've been wonderful to work withs" will mean just a little bit more. No matter what, there is one thing I now know for sure: Despite how important I feel today, I know that for many, as of June 2010, my season in their lives has come to an end. . . . .and again. . . .I'm okay with that, too.

"To every thing there is a season, and a time to every purpose under the heaven."

~ Ecclesiastes 3:1 KJV

With our current and former chief residents, Julie J-M, Gabriel W., Roy A., and Rosette C.