Reflections of a Grady Doctor after a Bedtime Story: The Gospel According to Shel Silverstein

"If you are a dreamer come in
If you are a dreamer, a wisher, a liar
A hoper, a pray-er, a magic-bean-buyer
If you're a pretender come sit by my fire
For we have some flax golden tales to spin
Come in!
Come in!"

~ Shel Silverstein

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I was sitting on the couch with my laptop on my lap, and thinking. . . .I want to write. I need to write. But there's a problem: I have nothing on the tip of my tongue or fingertips to write about. I felt my engine stalling. . . .

(Hmm. . . . could this be the aftermath of me now being 40? Let's hope not.)

I put down the MacBook and decided to wait it out. Vegged out on the couch with the kids watching "Astroboy" on cable. As soon as the credits rolled, I marched them to their bedroom.

"Just one book, pu-leeeeease?"

I thought of my friend and fellow Grady doctor, Lesley M., who agreed with her husband that they'd never say no to a request for a book to be read--an agreement that I also adopted. (Eh hem. . ."never" sounded like a good idea at the time, Lesley and Rich. . . . ) So anyways. . . .tonight, I broke out "The Giving Tree" by Shel Silverstein. The book is part sullen/part deep/part thought-provoking/part sleep-inducing. (And okay, just a wee bit depressing. . .but depressing in a good way. . . ) Anyways. . .it held the kids captive as always.

". . .and the tree was happy."

I snapped the book shut in an unspoken "The End."

"Read it again!"

"Yeah, Mom, puleeeeaaaase?"

"No, you little coco-pugs. Bedtime."

Once I finally got them settled in/tucked in, I found myself reflecting on the book we'd just read, and I thought about how much of my childhood was punctuated by Shel Silverstein's writings.

Hmmm.

Turns out that Shel was a pretty insightful dude. Next thing I knew I was looking through some of his classic children's poems and stories and. . .

Ah hah.

A "light in the attic" came on. . .just like that. Something to write about indeed. Why? Oh it's simple. Life as a Grady doctor totally overlaps with the gospel according to Shel Silverstein. Totally.

Wait.

Before I go on--could you possibly be one of those rare people who didn't grow up on Shel Silverstein masterpieces such as "Where the Sidewalk Ends" and "Lafcadio?" I will give the disclaimer that my mother is a retired elementary school teacher AND a ridiculously avid reader of all things literary. . . .but I'm saying. . .didn't everyone grow up being mesmerized by the late Shel Silverstein and his grainy black and white illustrations? If you, by some strange chance, did not then please excuse me while I turn my back, clutch my chest and . . .

::GASP::

Seriously? Seriously. A childhood without Shel Silverstein is a questionable childhood at best. (No offense to yours.)

Alright. . .so where was I? Oh yeah, the gospel according to Silverstein. Care to join?

*(All of the following quotes are the works of Shel Silverstein.)

***

"How many slams in an old screen door?
Depends how loud you shut it.
How many slices in a bread?
Depends how thin you cut it.
How much good inside a day?
Depends how good you live 'em.
How much love inside a friend?
Depends how much you give 'em."

Going in circles. . . .

There was this patient I had once who goes down in history as one of my most memorable Grady elders ever. No matter what I asked him, he had some circuitous comeback or pontificating response that never quite qualified as an answer. I thought my questions were simple enough, but I'd find myself in this crazy loop of Mr. Miyagi commentary that never seemed to have a real endpoint. Now y'all know how much I respect the Grady elders, so it's not like I could just throw my hands up and say, "Would you just answer the question already?!?" Instead, I just had to endure. . . .

"Hey there, sir. How are you feelin' this morning?"

"I'm still kickin' just not high, doctor."

"Oh. . .okay. Are you alright today?"

"Oh, now I'm always gon' be alright, now. 'Cawse I know a man who died on a cross and rose on the thoid day. . ."

"Yes, sir." (Grady rule #1: Never interrupt any Grady elder who makes reference to any part of the Holy Trinity.) I pause and wait for him to finish. "Soooo. . . .how are you doing, sir?"

"I don't know, doc. I ain't no count." Starts rubbing his abdomen. Belches.

"Uhhh, okay." (No count = not good or not well. Thanks, Dad for teaching me such lingo.) "Is your stomach hurting?"

"Sometimes it boils on me, but tha's okay. 'Cawse I ain't no ways tired."

"Yes, sir." ("No ways tired" = words in an old Negro spiritual. Grady rule #2: Old spirituals are also not to be interrupted.) I wait a few beats before asking again, "Sir, I'm just trying to get an idea of how you're feeling today. .to make sure I'm not missing anything. . . so your belly. . .how is it compared to yesterday?"

"Every day that I wek up and see a new day is better than yesterday. You see, 'cawse I know a man. . . " ("I know a man" = Elder reference to Jesus. Back to Grady rule #1.)

This cryptic circuit went on every morning for two full weeks for, like, thirty minutes an encounter. To this day, I'm still not sure whether or not he felt bad or good. Seriously, it was never clear to me. Either way, I came to enjoy our morning chats, even if I had no idea what to chart afterward.

***

"I cannot go to school today"

Said little Peggy Ann McKay.
"I have the measles and the mumps,

A gash, a rash and purple bumps.

My mouth is wet, my throat is dry.

I'm going blind in my right eye.

My tonsils are as big as rocks,

I've counted sixteen chicken pox.

And there's one more - that's seventeen,

And don't you think my face looks green?

My leg is cut, my eyes are blue,

It might be the instamatic flu.

I cough and sneeze and gasp and choke,

I'm sure that my left leg is broke.

My hip hurts when I move my chin,

My belly button's caving in.

My back is wrenched,
my ankle's sprained,

My 'pendix pains each time it rains.

My toes are cold, my toes are numb,

I have a sliver in my thumb. My neck is stiff, my voice is weak,

I hardly whisper when I speak.

My tongue is filling up my mouth,

I think my hair is falling out.

My elbow's bent, my spine ain't straight,

My temperature is one-o-eight.

My brain is shrunk, I cannot hear,

There's a hole inside my ear.

I have a hangnail, and my heart is ...

What? What's that? What's that you say?

You say today is .............. Saturday?

G'bye, I'm going out to play!"

Mourning sickness. . . . .

There was once this resident rotating with me on wards who was about 15 weeks pregnant. She confided in me early in her pregnancy, and also did not hesitate to let me know how obstructive pregnancy was to anything more than the most basic patient care. (She didn't seem impressed by the two pregnancies I worked through on wards. . .)

Me: "How 'bout you give us a lecture on hyponatremia?"

Her: "Oh, my legs get tired when I stand at the board."

Me: "You can sit if you'd like."

Her: "But I get out of breath from all that talking."

Me: "Okay, then you can just make us a handout."

Her: "I have terrible carpal tunnel already."

Me: "Uhhh, okay."

Her: "Hey, Dr. Manning?"

Me: "Yes?"

Her: "Don't forget I have Saturday off. . . ."

Me: "Yes, I remember. Is everything okay?"

"Oh, yeah! I'm doing a triathlon!"

Um yeah.

****

"There is a voice inside of you
That whispers all day long,
'I feel this is right for me,

I know that this is wrong.'

No teacher, preacher, parent, friend

Or wise man can decide

What's right for you--just listen to

The voice that speaks inside."

The Hard Choices. . . . .

I was once talking to one of my most favorite former-Grady-doctors ever. She was struggling with a decision to continue working at Grady, or take a different job. Now y'all know how much I love me some Grady Hospital--but the job opportunity in question seemed like a really great fit for her. She was so conflicted! I sat and listened as she rattled off all the pros and cons of each. As badly as I wanted her to stay and be a Grady doctor with me, it really sounded like her decision was already made before she even knew it.

"But I don't know what to do," she said tearfully. "I love Grady, but. . ."

"Listen to your spirit," I replied. "What's your spirit telling you?"

She started crying. Hard. I just sat there watching her from the other side of my desk. Hunched over with her face in her hands, weeping.

"There's your answer, and don't worry. It's always hard to say goodbye to someone or something you love. Just know that more love awaits you."

Just know that more love awaits you? Whew. I have no idea where all that Jedi Master deep-ness came from, but thank goodness it came when it did. Too bad I wasn't on a Shel Silverstein kick. I could have just whipped out "Where the Sidewalk Ends" and had her read that poem. See? I'm saying. Shel was dope.

***

"Sandra’s seen a leprechaun,
Eddie touched a troll,

Laurie danced with witches once,

Charlie found some goblins gold.

Donald heard a mermaid sing,
Susy spied an elf,

But all the magic I have known

I've had to make myself."

Magic in the hospital. . . .

When I was a medical student, I never seemed to be the one that ever saw the exotic cases of anything. Nobody ever seemed to seize in front of me or exsanguinate before my beady little eyes. Every heart murmur I heard was an "innocent" one and even when I thought a patient had a mass in the roof of his mouth one day, even that turned out to be a "normal variant." Dang.

One day in the cafeteria, third year medicine clerkship circa 1994:

"I admitted a lady with acute intermittent porphyria last night!"

"Oh yeah? Well, I helped code a man in heart failure from wet Beri-Beri!"

"What did you see, Kim?"

"Errrr. . . .I saw a lady who ate at the all-you-can-eat shrimp feast at Cap'n D's and got the gouch in her big toe."

::crickets::

(Okay. . .although seeing gout (a.k.a. "the gouch") is not like seeing a leprechuan, I've since learned that since common things are common, seeing all of those "bread and butter" cases in med school was a good thing.)

***

"Tell me I'm clever,

Tell me I'm kind,

Tell me I'm talented,

Tell me I'm cute,

Tell me I'm sensitive,

Graceful and Wise

Tell me I'm perfect--

But tell me the TRUTH."

Feedback. . . . .

(This is what I'm subconsciously thinking when I solicit feedback from my husband . . .and from your blog comments. . . .hee hee. . . .wait, did I just say that?)

****

"Said the little boy, "Sometimes I drop my spoon."

Said the old man, "I do that too."

The little boy whispered, "I wet my pants."

I do that too," laughed the little old man.

Said the little boy, "I often cry."

The old man nodded, "So do I."

But worst of all," said the boy, "it seems

Grown-ups don't pay attention to me."

And he felt the warmth of a wrinkled old hand.

I know what you mean," said the little old man."

Kindred spirits. . . . . . .

This little ditty reminds me of why it's so beautiful to have medical students in the hospital. They have the most time to give, and their undivided attention can be such a blessing to sick patients. I remember being completely ignored by my attending during my 3rd year clerkship in Internal Medicine--so much so, that I was convinced that I would never, ever do Medicine. I initially thought I'd be a surgeon. . . . .until I discovered that I loved the post-op patients and consults on the surgical service, but not the OR. (Turns out that you need to like the OR if you want to do Surgery. . .picky, picky!)

I later learned that even though some of my attendings back then wouldn't know me if I walked up and smacked them across the face. . . .my patients knew me and appreciated my presence. Sometimes the patient and the medical student have more in common than they realize. I tell the students of how pivotal their role is to scared patients. I also tell them that you need that patient just as much as that patient needs you.

****

It was missing a piece.

And it was not happy.

So it set off in search

of its missing piece.

And as it rolled

it sang this song - "Oh I'm lookin' for my missin' piece

I'm lookin' for my missin' piece

Hi-dee-ho, here I go,

Lookin' for my missin' piece."

A perfect fit. . . . .

This book by Shel Silverstein-- "The Missing Piece"-- makes me think of my life before Harry and the boys. I can't say that I was really unhappy, per se--but something was missing. The ending of the book makes me happy because it reminds me of when I first met Harry. I guess the way I remember it is kind of like this. . . . I was just a-singing and a-rolling along like the circle missing the piece. Hi-dee-ho, here I go. So glad I found my missin' pieces!

Found: my pieces that I love to pieces

***

"Would you like to hear

of the terrible night
when I bravely fought the---

No?

Alright."

The late night storyteller. . . . .

Bwwah hah hah! This essentially describes one of the reasons I started this blog in the first place. Harry a.k.a. "the person who originally had to hear every one of my Grady reflections before this blog." My poor, poor husband. He'd lay in bed at night listening to me rambling on and on with my intricately detailed Grady tales. . . . .

"And then, you won't believe what happened next, babe!"

Snort. "Uh. . . huh? I can't believe that, babe."

"I didn't say anything yet, Harry." Snort.

Snort. That was the sound of Harry dozing off with the tiny snore that he would swear up and down was not, do you hear me? Not a snore but a wide awake snort.

"I'm listening, babe. I am listening."

"Okay, well then. . the nurse comes up to me and my team and says. . " Snort.

Starting this blog sort of let Harry off of the hook. Sort of. (Okay, I do still tell him quite a few of my stories, and okay I admit, sometimes make him listen to me read him my blog posts aloud. . . .)

So on behalf of Harry and me-- thank you for reading. . . .and for coming in and sitting by my fire. For truly, my friend, we have some flax golden tales to spin indeed. :)

***

If you didn't (gasp) grow up on Shel Silverstein. . . .and even if you don't have children. . . .please. . .
don't go another day without the gospel according to Silverstein. . . .

Reflection on a Tuesday: Black and White

pt. names, details, etc. changed . . . you know the deal, man
a "black and white" cookie, Brooklyn style

_____________

"Sir, I know that was a lot of information. I just want to be sure I did a good job explaining to you, okay? Can you tell me why we said you were in the hospital?"

"Sure, Miss Mannings. Y'all said I got pneumonia in my chest but then when you looked closer you saw a spot, too. Since I smoke, you want to be sure that it ain't more than just pneumonia and not something like a. . .cancer?" He smoothed the covers out over his long legs and rested his pecan colored arms on top of the blanket. His cheeks were covered with a smattering of moles and skin tags, likely from years of working out in the sun doing construction.

I drew in a deep breath. "Yes, sir. That's correct." I felt the need to make it sound less daunting. "But we aren't saying that what we saw looks exactly like cancer either, sir. I admit it was concerning." Great, now I'm backpedaling. "I mean, it's just that it's important to be sure, sir. That's why we are having you get that test by the pulmonologists or lung doctors. Do you remember what I said that test was?"

"You talking 'bout that test with the camera down your throat?"

I wished that his graphic description wasn't spot on, but it was. His wise sixty-something year old eyes didn't look the least bit fazed by the idea of something sounding so noxious as a "camera down your throat." Again, I wanted to dampen it a bit. "Umm, well. . .you know they do make you drowsy for the test and then carefully put this very small tube with a camera on it through your mouth to get to your windpipes. That's how they are able to see inside your lungs."

"Right. Down your throat, and then they stuff it in your breathing tube. That man said it's like a tree that they look down all the branches of. As I thank of it, I'm guessin' sometimes it ain't nothin' but leaves when they look, but sometimes it's something else growing on the tree that ain't 'posed to be there. Like cancer." He let out a nervous laugh.

I couldn't argue with his accurate description, and was admittedly quite impressed with the metaphor he used. The timing couldn't have been better--we had just had a lecture earlier that week on "Health Literacy" that was really driving home the importance of making certain that our patients understand what we are doing and saying. The lecture emphasized the need to say things in black and white, instead of chartreuse and celadon. Even though the plan itself wasn't that great for him, this was an example of a successful "teach back." The team listened quietly and seemed to acknowledge this as a teachable moment.

I turned toward the team and said, "It sounds like Mr. Chambers has an excellent understanding of what's going on with him!" I looked over at the patient and smiled. He returned the expression, but shortly after furrowed his brow and turned his lips to the side. Something was puzzling him. "Wait, Mr. Chambers--did I speak too soon?"

He chuckled and said, "Naw, I know what y'all doin' today. This my body. . .shoooot. . . you know I'm gon' know when it come to my body!" But then he narrowed his eyes and looked like his wheels were turning again. It was confusing.

So then I remembered the other health literacy guru tip that often gets forgotten. Instead of asking folks "do you have any questions," you pose the question the way I asked Mr. Chambers:

"Sir, what questions do you have for us?" I gestured to the medical student, Ania, who'd been carefully doting over him throughout his hospitalization.

I felt pretty sure that he would have at least one, especially with that puzzled expression he kept offering me. I was right.

"I don't have no questions for her," he spoke firmly while pointing directly at Ania the way Zachary points at Isaiah when I ask who did something, "but I DO have questions for you, Miss Manning."

I felt relieved that he was willing to ask what was obviously becoming a pressing question. "Okay, Mr. Chambers, go right ahead."

He stared at me for a few seconds like he was deciding on a Final Jeopardy answer, and finally broke the silence by saying, "Miss Manning, are you black or white?"

I raised my eyebrows in surprise and looked over at Ania who immediately blushed, initiating a domino effect with the rest of my all fair-skinned team.

Now here's the deal: I am not offended by this question, nor are my feathers ruffled in the least when it is asked--but the thing is that I usually see it coming. (See this post about Grady and the race to determine my race.) Furthermore, it always amuses me since when I look in the mirror, I see a black woman looking me squarely in the eye, albeit one with freckles.

"Am I black or white?" I repeated for clarity.

"Yeah. What are you?" He looked at me as if this were not a not-so-PC way of asking such a thing. For him, obviously it wasn't.

"What do you think I am?" My team couldn't figure out if I was embarrassed, amused or what. They shifted on their feet, somewhere between uncomfortable and intrigued.

He studied me for a few minutes and then said, "I was thankin' you was black, but I don't know. You sound black. If you ain't black, you sho' sound black."

My team was now crimson. I laughed out loud to lighten things up and let the team know that I was okay. "Okay, so here's the deal, Mr. Chambers. . .my mama, she's black and my daddy, he's black. Does that help?"

Instead of thinking this was cute, he sat there thinking as if I was Rumplestiltskin asking him to guess my name. He tapped his finger on his lip and sighed. Still in Final Jeopardy mode. I knew I'd need to let him off the hook.

"Mr. Chambers, I'm actually black." He nodded his head like that's what he was going to say and smiled. "Was there a reason you wanted to know this?"

"Honestly, doc? I was just curious. I just be wantin' to know stuff like that and I get real curious, and you seem cool so I figured I could ask."

"Does it make a difference to you? I mean, are you okay with a black doctor and . . .the rest of our doctors?" I nodded my head to Polish Ania, Taiwanese Emily, and the rest of our team of varied European descent.

"Oh yeaaaaaah," he laughed in the most unassuming way ever. "Don't matter what y'all is. I just be wantin' to know little stuff like that, tha's all. All y'all cool wit' me. Black, white, blue, whatever!"

Nice.


So that was that. My patient who might have a primary lung cancer--a possibility that he fully understood--did have a question indeed. It wasn't the kind of question I expected but that's what happens when you ask, "What questions do you have for me?" -- and that's what happens when you have the distinct pleasure of working at a place like Grady Hospital.

Morning Haiku: Reflections on What I Heard This Morning Before Even Getting Inside of Grady Hospital

acrylic on canvas by my brother, Will Draper, DVM 6/94
(who must have intuitively known that I was destined to be a Grady doctor)

__________________________________________________________

Sounds while walking in:


"Doctor, can you spare some change?"


"I like your hair-do."

______________________________________________________________________________

I love this job. :)

Reflection on a Sunday: Haiku on the First Day of Grady Wards

Entering the wards


God, help me help my patients


For I am just one

Verbatim at Grady: A Sweet Connection

Verbatim at Grady:

Lady walking through the Grady hallway. Catches the eye of a dude walking through the corridor, who decides try his luck.


Man: "Hey there, Miss Lady. . . how you doin'?" (definitely being fresh.)

Miss Lady: "Oh, I'm good. You?" (not minding him being fresh at all.)

Man: "I'm just chillin' going over here to see my doctors 'bout my sugars."

Miss Lady: "You got diabetes???" (Fireworks go off. Points at Man. Now pats her buxom bosom gleefully.) "Whaaaat? Oh my GOSH! I got diabetes, too!!"

Man: "You DO? That's why you seem so sweet." (Whoops, threw up in my mouth a little bit.) "You go to Diabetes Clinic or regular clinic?" (This is truly their "moment." Like, a "OMG, you went to Morningside High? Me, too!" moment. Fraught with peril, I say. . .)

Miss Lady: "I go to both. Diabetes Clinic be giving you free stuff. They don't give you nothin' free up in regular clinic." (I work in "regular clinic" so I take offense to that.)

Man: "Alright then. . .I'mma remember that. . . . I know they gon' flip out when they see my sugar today 'cause it was higher than 400."

Miss Lady: "400! Damn! What you ate this morning?"

Man: "A sausage biscuit from McDonalds." (Starts laughing hard) "But shooot, I be hongry when I'm waiting." (Laughs some more. The connection gets even tighter.)

Miss Lady: "I hear you." (A little bit flirtatious.)

Man: "I hope they don't try to make me go to emergency 'cause my sugar so high."

Miss Lady: "Naww, chile please. They gon' make you drank a big ol' pitcher of water and then they gon' let you go long as your sugar come down good. Trust me."

Man: "Good." (Flashes her his big ol' smile with missing canine on right.)

Miss Lady: (She obviously liked his smile, missing canine and all.) "You know you wasn't 'posed to be eatin' no sausage biscuit for you came up here!" (laughing, even more flirty, batting what appears to be glue on lashes. Eeeww.)

Man: "Shiiiit, you know I'm gon' tell 'em I'm fasting." (Now they both laugh. My mouth falls wide open.)

They look at me and catch me eavesdropping and then both laugh some more. Not sure it they were laughing at me for believing that people are actually fasting when they say they are (cause I generally do believe them) or just laughing 'cause I overheard them. I think it was the former and not the latter.

Man: "Alright then Miss Lady. I hope to see you around." (Is he gonna ask for the number? Hmmm. . .)

Miss Lady: "Maybe we'll see each other in the Diabetes Clinic." (Bats scary lashes again. . .so wants to give him her number.)

Man: "That's what's up." (Winks at her and gives her one more once over before walking into "regular clinic." Eeeww. Oh, but left her hanging on asking for the digits. She almost wistfully watches him disappear through the door. And somehow I detect a wee bit of disappointment from her. . . .disappointment about missing out on a diabetic mack daddy with a missing canine, a receding hairline, and a blood sugar of 400. :::w-ow:::)

***Love, love, love this job.***

:::sigh:::

Reflection on a Friday: Say What?

(*names, details, etc. changed. . .you know what's up)

(A big-a, red-a sock)

______________________________________________________________
"Why don't you say what you say when you say what you said anymore?"

- from Jermaine Jackson's "Do What You Do"
_______________________________________________________

I often wonder what's the best approach to teaching about patients at the bedside on rounds--in front of the actual patient. I struggle with vacillating between medical language and living room language, feeling like I'm some bilingual person that is neglecting to fully interpret everything to the monolingual bystander. Because of this, I try to pay attention to how I talk to patients, and also about them. And usually, I will offer a disclaimer before I speak in our "other language."

It turns out that some of the terms used in every day English mean something different in Med-lish. And, like I said, usually I'll remember that when I'm talking. . . .that is until I run across an unexpectedly exciting medical encounter. Here's an experience I had where all my medical manners went out the door (all secondary to my clinician-educator nerdiness.)

_________________________________________________________
This one time, on the Grady wards. . . .

"Hmmm. . . . impressive," I said on rounds one day while looking at our patient's leg with my team. "Really impressive." The interns, student and resident gazed at the limb-in-question, doing their very best to take mental note of what qualifies as "impressive" by an attending. I quickly turned my attention to Mr. Banks, our patient, who was anxiously following our discussion. I offered him an easy smile which seemed to relax him a bit. "Sir, we're just shop-talking for a few moments. We promise to explain everything we're saying to you in a few moments, okay?" He nodded, but still watched us intently.

"He said that this started two days ago as a little bit of erythema, but then it just evolved into this confluent, angry eruption," spoke the senior resident."The good news is that his blood cultures are negative and his temperature has already come down nicely with this antibiotic regimen."

I followed the redness down his calf to the top of his foot. It looked like a shiny, red boot made of skin. "Wow, this is angry." I reached down and touched his skin gently with my gloved hand. He winced and I stopped abruptly. "Sorry, sir," I apologized. He nodded again and smiled bravely. "Mr. Banks, has anything like this ever happened to you before?"

"Naw, not really. I mean this one time, I had the cellulite on my foot after a sore got infected, but they didn't even keep me in the hospital for that. I just took some pills and it got better. This time? Shoot, it's waaay worse."

"Hmmm," I murmured while still studying his leg. Now that it was clear that he was clinically responding, I allowed my inner clinician-educator-nerd to be unleashed. OMG, erysipelas! I haven't seen or talked about erysipelas in forever! Cool, man. This is a really cool case. I could feel myself getting ready to foam at the mouth from excitement about this upcoming teachable moment.

Why, you ask? It's what nerdy clinician-educators do. I mean. . . .imagine running across your most favorite episode of Good Times or What's Happenin' that you haven't seen in like, forever and ever, but that you loved and remembered every punchline to. (Whoops--just realized that not everyone reading this is an African-American raised in the 70's. . .uh. .my bad. . . so. . .make that, errr. . .Buffy the Vampire Slayer. . .errr. . . .or Dawson's Creek, maybe? Look, you get the picture.)

"Mr. Banks, sir?" I queried. Mr. Banks looked up at me with raised eyebrows. "I'm going to chat with the team a bit, okay?"

"That's cool, Miss Manning," he answered while reaching for his cell phone amidst the heap of sheets on his hospital bed. I redirected my attention to the medical student standing next to me. This is so cool, I thought. Hmm. . .how will I even begin?

"Ronald, what is St. Anthony's fire?"

He looked startled, and then cocked his head and pursed his lips. "Beg pardon?"

I smiled and cleared my throat. "St. Anthony's fire," I repeated. "Have you ever heard of St. Anthony's fire?" The interns looked at each other nervously, knowing how predictably such Socratic questioning moves up the food chain. They both immediately stared at the floor when Ronald shook his head no. "Phone a friend, Ronald. Who's your consult?"

"Errr," he glanced at the two interns quickly, "errr. . . .Sharon." He shrugged his shoulders and offered her an apologetic grin. I moved the spotlight to Sharon, one of the interns.

"Is it, like, some kind of . . . .uh. . . . medical thing?" she stammered.

"Yes. It actually is a term used to describe two different things, but since we're in the United States, I'm referring to only one of them. Do you know what condition is referred to as 'St. Anthony's Fire?'"

Foster, the other intern, piped in before he could get placed on the hot seat. "Is it used to describe cellulitis?"

I delicately pulled the cover back from Mr. Banks' leg to fully expose the skin above the knee, using care to respect his privacy. "Look how angry this skin is," I pointed out. "Now notice how the skin is intensely red and raised but then how right here all the angry area abruptly stops. This sharp border here is called a leading edge. Mr. Banks has more than just a cellulitis." The team nodded intently.

"I coulda told you that!"remarked Mr. Banks. "When I had the cellulite, it was red, yes, but naw, it didn't have nothin' on this here."

"Right, Mr. Banks," I acknowledged, "You are absolutely right, sir." Everyone looked at Jenny, my senior resident. She was last on the food chain. "Okay then, boss, what would you call this?" I offered her a half-smile.

She squinted her eyes and took an exaggerated breath. "Erysipelas, Dr. M? I've only read about it, but would you call this erysipelas?" (I love it when learners answer my questions with questions.) I gave her a congratulatory nod. "St. Anthony's Fire?" she added. "I don't know that part, though." In other words, Don't even go there, Manning.

(Erysipelas, courtesy of ADAM online health photos)

"Yep. That's what they used to call erysipelas back in the day. St. Anthony spent most of his life in the desert, and honestly, that's about as much as I know about him," I told them. "In some countries, they call ergotism, or any overdose on ergot derived medications, St. Anthony's fire. Here in the states, if you hear that term, it's most likely erysipelas." No one said anything so I went on, still enjoying every second of the subject. "Erysipelas is almost always caused by invasive streptococci. What really distinguishes it is the extreme confluent erythema and induration with blistering, see? And that classic leading edge. Folks used to draw cultures by aspirating a bit of fluid into a saline-filled syringe right from the leading edge." I still had a captive audience. Now I was in my rabid teach mode; a very dangerous zone for lazy learners, which fortunately, this team did not have. "In the pre-antibiotic era, this was a tremendously feared and deadly infection--especially in babies."

"Babies?" gasped Sharon.

"Yep, babies." I continued. "The majority of cases used to be on the face, but the extremities, especially the legs are also well described affected areas. Some of the worse cases you can see are on the face."

"Damn!" exclaimed Mr. Banks causing all of us to startle. "I'm glad this ain't on my face!" We all collectively smiled, wholeheartedly agreeing with our patient. He seemed to like the attention. "Miss Manning, I learned a whole lot just now. When my old lady come up here, I'm gonna tell her I got the St. Elmo's Fire!" This time I couldn't help but laugh out loud.

I reached for the clear bag of antibiotics hanging from his IV pole, turned it over, and read the label. "Mr. Banks, this medicine is already attacking the germ that's causing this problem. I'm hoping this will get a lot better while you're here."

The resident explained the rest of our plan to Mr. Banks and we prepared to continue our rounds. This is good medicine, I thought feeling proud of our interaction with Mr. Banks. Our team is practicing good medicine. I punctuated the encounter with my standard question of all patients every morning, "What questions do you have for us, sir?"

Mr. Banks winced and gingerly place his leg on top of a pillow. Then, he snapped his finger and said, "You know what? I do got some questions, doc." I raised my eyebrows in anticipation. "First, why you first said my leg was 'impressive? really impressive?' Then what is 'confluent ery-deema?' Y'all said that twice. Oh, yeah, and why you kept calling my leg 'angry?'" The whole team laughed. But Mr. Banks didn't.

I felt my face growing a little hot with embarrassment. I couldn't believe I'd done that. The residents all know how much I emphasize avoiding too much medical jargon at the bedside of patients. How could I have gotten so caught up in this "cool case" that I'd forgotten to follow my own ground rule: "Listen to yourself and your team speak, and autocorrect as you go." Uggh!

"Um, Mr. Banks? Uhh. . .I think I owe you an apology." The team looked intrigued. "Sir, I haven't seen any one with. . .well 'The St. Anthony's Fire' in quite some time. I got so wrapped up in talking about you that I forgot about how I was talking to you and about you." I let out a sigh and started to answer his questions. "First, I shouldn't have said 'impressive.' It was really me saying that I hadn't seen skin this. . . .well. . . .angry in a while. When I say angry, I'm talking about how red and warm your skin is. . . ."

"Kinda like how somebody look right before they 'bout to kick somebody's ass?" laughed Mr. Banks amusing himself with the metaphor. I was glad he was being a good sport.

"Yes, sir," I replied while pointing my index finger at him for emphasis, "Exactly like that. And the 'confluent erythema' is just a term we use to describe when. . . all the red, angry parts start running together."

"Like a big-ass, red-ass, hot-ass sock on my leg, huh, Miss Manning?" We all laughed again. This time, Mr. Banks laughed, too.

Lesson learned from Mr. Banks:

Sometimes the patients are better interpreters of our medical language than we are.

True stories: Fatter not Phatter, Big Boned-edness, and Relief in Dolby Stereo

Fat (adj.): Obesity; corpulence.

Phat (adj.): Slang term for something that is excellent or attractive.

True stories. I ain't lyin'. (Hand over heart)

The following incidents happened to me at Grady on both today and yesterday, respectively:

Grady Seinfeld moment #1:

Stepped on the Grady 'A' elevators at 12:20 pm today. This environmental services lady (a different one) pushing cart of cleaning supplies says to me in front of the other five people on the elevator, "I seen you on Fox 5, doc. You know you look fatter on TV than you look at Grady." Again? You've got to be kidding me! Maybe she meant I looked "phat" not "fat" (She quickly clarified that for me.)

"Not like you look fat-fat, I mean you just look like you a LOT thicker on TV, you know like you just more big boned-ed." Big boned-ed??? Wo-ow.

A couple turned around and nodded . . . .still not sure if that nod was "yeah, I have seen you on Fox 5" or "hells yeah! you do look fatter (not phatter) on TV!"
Was too scared to ask. Prefer denial on this one.

Grady Seinfeld moment #2

Yesterday, I was sitting in the family waiting room having a meeting with my resident, Stacie S., on the 9th floor family meeting room. It's a very serene room with couches, a table, comfy chairs and such--meant to feel "homey" especially during family meetings (which we had just finished having.) Usually, if someone inadvertently pops their head in, they immediately retreat if it's obvious that someone is having a serious or private discussion (which we were.) Okay, so there is a bathroom just as you enter the room, and this random, twenty-something year old guy walks in the door and points to the restroom. We suspect he stepped in on accident, so we prepare to redirect him to another bathroom. Before we could say anything, the dude goes in the bathroom, DOESN'T CLOSE THE DOOR, and urinates for what seemed like an hour straight. I am convinced that he drank 8 liters of Coca Cola, held his bladder for 36 hours before coming in there, and was in some perverse way proud to demonstrate to us that he could pee in Dolby stereo. What??? Who does that???

Okay, so the dude waltzes out of the commode and me and my resident just looked at eachother and then him in disbelief. That Grady familiarity kicked in and I said, "Awwww, come on, dude! Next time close the door- especially with ladies in the room!" He did not look one bit embarrassed. For minute I thought he was going to say, "What ladies?", but I was relieved when all he said was, "My bad, doc! That's my bad." While zipping up his pants, and arranging himself. (Sorry, I just threw up in my mouth a little bit.)

Awwwww man. . .just thought about it! He didn't bother to flush OR wash his hands either. . . . . .

Take home messages:

1. As long as you think you're phat when you look in the mirror, that's all that matters.

2. If you must arrange yourselves, gentleman, do it in private.

Elevator Observations Part III - Quasi-Celebrity? You decide.

I ain't on some "oh, I'm a celebrity"
I deal with the real
so if it's artificial let it be.

- from The Roots
"Baby, You Got Me"

So, here's something funny. A little over a year ago, the head of nursing along with some one from Grady public relations approached me and my two friends/fellow Grady doctors, Neil W. and David M., about taking a photo for a handwashing campaign they were unrolling at Grady. "Having some of our Grady doctors along with some nurses would send a great message," she said. "What I have in mind is some nice laminated posters to put on the wards with a catchy slogan about hand hygiene." I'm down for some clean hands, and also down for Grady, so I went along with it.

We meet up a few weeks later, and get our picture taken by a professional photographer in front of this funky green backdrop. (I have since learned that such funky backdrops are actually quite high tech, depending on what you plan to do with the photograph.) They posed us into these very "somebody posed me" positions, and after about 30 minutes we were done. I recall receiving an email with a proof of the picture, along with a kind word of thanks from the head of nursing for our participation in promoting clean hands at Grady. Again, I am down for some clean hands, and also down for Grady, so I remember saying something like, "Cool, my pleasure."

So fast forward a few weeks or maybe a few months to the beginning of August 2008. I walk through the doors of one of the main entrances to Grady, and what do I see? This ginormous banner scaling the wall with hands the size of King Kong's when he scooped that screaming blonde out of that building. The hands look ultra sanitized and are surrounded by these animated bubbles. . . .below them is the what obviously won the catchy slogan contest-- "CLEAN BECAUSE WE CARE!" Aaaaah, but the best part? Nestled just beside the King Kong clean hands--no exaggeration--was a life size print of the picture we took in front of the funky green backdrop. (I should've known something was up when they put us in front of that thing.)

I was dumbfounded, gobsmacked, and whatever other word you can come up with to describe something that dumbfounds or gobsmacks you. Hello? This wasn't a laminated poster! I couldn't decide whether being on the Grady jumbotron was kind of cool or really, really weird. I have since settled on something in between.

Riddle me this: What's the only thing more bizarre and gobsmackable than unexpectedly walking into a lifesize picture of yourself in the lobby of Grady Hospital? Try unexpectedly walking into a lifesize picture of yourself in the other lobby of Grady Hospital. . . .and in the cafeteria of Grady Hospital. . . .and on nearly every floor of Grady Hospital! (Picture me with big, fake smile and fingers in my dimples)

Now, of course this has led to a myriad of comments from everyone from students to janitors to patients to complete strangers. Sometimes they just stand next to me at the elevator and do a double take, saying nothing. Other times, they come right on out with a comment.

My favorite one of recent memory happened just a few weeks ago. There was this Grady environmental services employee who joined me on the elevator near one of the scary, lifesize photo banners with the King Kong clean hands. She looked at the picture, and then at me. Back at the picture. Back at me. Here we go. When our elevator came and we stepped into the empty car together, she didn't hold back.
"You know what, Miss Manning?" Deep breath. . .this is Grady, so this could go anywhere. "You was fatter when you took that picture," she told me matter-of-factly.
I sort of smiled at her; the kind of smile you give someone when you taste a mouthful of something they cooked and it really, really sucks but they think it's worthy of Top Chef.

"Was that right after you had your baby? I remember when you was pregnant." Wow. Not the postpartum headcrack!
"Um, no," I tried to answer cheerfully, "my baby was almost two when I took that picture." Let's end it here. Good place to end it. We can ride this thing out with awkward silence. Better yet, let's just talk about the "Real Housewives of Atlanta." That always goes over well in the Grady elevator.

"Oh, okay then. You must've just been eating more back then, 'cause you was fatter on that picture." Wow, this is brutal. "But you was still cute. But you was fatter, though." Aaaah. At least I was still cute. Hmmm. Trying to decide if I ever want to be referred to as fatter. Looking her up and down now and trying to decide if I should tell her my assessment of her appearance, because I do have one.

"Really in your face, though." What?
"Beg pardon?" I spoke aloud. Immediately, I regretted it because it clicked right then that she was still on the "fatter" thing.
"In your face, you was fatter," she clarified as she inspected my face. Were fatter. WERE not was fatter."But you was still cute." See, Kimberly? There is a bright side. Was cute or were cute works for me.
"Even though they put too much make up on you. But you was cute even with the make up and your face fatter." Is she serious? Why is this lady hazing me? Doesn't she know I'm almost 40, and all weight-related comments good, bad or indifferent get internalized and compartmentalized forever? Dude, let me get to my floor. More people getting on. Sweet. Maybe she'll stop.

She stepped aside to let folks into the elevator but that didn't stop her. "They had a professional do your make up? Or did they airbrush it?" Killing me. Hope my expression does not show what I am thinking.
"You know they can airbrush pictures. You could have told them to airbrush it so your face wouldn't look fatter." She cannot be serious.
"That's what they do to Tyra and Michelle Obama. Oh yeah, and especially Oprah for that magazine of hers." Bananas. "They look a hot mess and then they get airbrushed. You shoulda had them to just airbrush you, Miss Manning. 'Specially since they all over the hospital." Oooophh! Body blow. Thanks for reminding me. All over the hospital, on every floor, and probably on a MARTA bus somewhere. Okay, I give up- can't take it any more. Need to attack before further annihilated.

(Insert cheery, fake smile here) "Nope, did my own make up, wasn't pregnant, and think I may have even been lighter in weight then than I am now." (Cheery, fake smile even bigger now.) "Glad you thought I looked cute, though." 7th floor. Finally saved by the bell. Okay, can't resist one more little dig.
"Will ask for that airbrushing next time they take a lifesize picture of me to plaster all over Grady." Snarky, I know. But she was asking for it.

Now I have since decided that her commentary was meant to be some sort of unknowingly camouflaged compliment. That whole episode has been added to my list of Seinfeld-esque moments I'm stacking up from my Grady experience. For a brief spell, I felt bad about my snarky sarcasm, but my sneaking suspicion is that she didn't even catch it. Especially because she had smiled and waved saying, "Alright then, Miss Manning!*" when I exited the elevator.
*(Remember "Miss Manning" is a term of endearment.)

Take home message: Being on the Grady jumbotron seems to have given folks in my Grady family this green light to have familiarity with me. And in a strange way, that part is kind of cool. . . .

So I guess I'm a somewhat of a quasi-celebrity inside of Grady. As long as nobody paints a mustache on my fatter, non-airbrushed, overmade up face, I'm okay with it. :)

Never clock out

I had to work this morning. . . .yep, on a Sunday. Not exactly my first choice of things to do on a Sunday. . . .my preference is to go to church with Harry and the kids. Yeah, I was a little groggy when I first woke up, but a wonderful early morning snuggle session with Zachary on the sunroom couch was just the pick-me-up I needed before heading in to tackle the day at a "sho 'nuff "county hospital. Something about the innocence of 2 year old conversation--butterflies, Blues Clues, and big-boy underwear--lets me know that everything is alright with the universe. :)

Good morning, Grady!
(Here is a picture of Grady that I took right before walking in this morning.)


Some parts of morning rounds were rough. One person tearfully told me that no one in her whole life has ever loved her, and that she feels like a worthless mistake every single day. Someone else sat across from me as I discussed end-of-life issues regarding her dying loved one. One guy was stressed out because someone kicked the door in at his house while he lay in the hospital trying to get well. For him, a life or death situation in the hospital has become a life or death situation outside of the hospital, too. Another young woman took down my personal cell phone number so that she could talk to me more about a critically ill parent under my care. She asked me for the "best way to reach me" and sounded really upset. I wanted to tell her to have me paged. . .but the real answer was that the best way to reach me is my cell phone. . . .maybe I'll regret it, but right now, it seemed like the right thing to do. And lastly, I consoled my resident who was on the brink of tears all morning; not because she is a crybaby, but because she is an empathic young doctor who is now grasping the magnitude of what we do every day. It's an awesome responsibility.

This ain't a job for the faint of heart. These are human beings we are caring for, hoping for, and fighting for. We clock in but, in our hearts, the best doctors can't clock out no matter how hard they try. We are haunted by our patients and their stories, we hunger to learn more to understand their problems, and then we strive to do just a little bit better each time.

Now that it's all said and done, I guess I'm not so bummed about missing worship service today. Sometimes going into Grady on a Sunday kind of feels like going to church. Afterall, working at Grady is a ministry in itself. . . . .and something about squeezing my own loved one tight this morning made me want to try just that much harder so that my patients can do the same. (Zachary and me during our snugglefest this morning)

Miss Manning, but not if you're nasty

Sometimes, no a lot of times, my Grady patients call me "Miss Manning" - even though they know I'm a doctor. It used to seem a bit curious to me, but my good friend and fellow Grady doctor, Lesley M. told me that she sees it as somewhat of a term of endearment. I think I am starting to agree with her on this one. No one ever says "Miss Manning" with a nasty snarl or a roll of their neck. In fact in the countless numbers of times I have heard expletives in the hospital, never once was it paired with the infamous "Miss Manning." In my experience, folks who want to curse you out generally get the title correct. (Not that I am the target of frequent cuss-outs. . . .however, you will come to learn that in a sho-nuff county hospital, you could very well get randomly cursed out for just standing there.) Anyways. . . .Lesley is probably right on this one- kiss my *expletive* is almost always followed by "doctor."

And so . . . . this morning I was rounding on one of the patients on the inpatient service with an intern and a student, and as always, I reintroduced myself as "Dr. Manning, the senior doctor on the team." The intern went over the plan with our patient, and referred to me, Dr. Manning, several times. She even said, "Dr. Manning wants to examine you now if that's okay." We finished the encounter, which was quite pleasant. The patient asked a few questions which we patiently answered, shared a bit of small talk and then bid her adieu. We'd been in there around 7 or 8 minutes or so, and I even wrapped up the visit by pointing to my badge and saying "If you have any questions or concerns, my name is Dr. Manning." Sure enough, as we walked out of the room, the patient smiled wide, raised her hand, and hit me with a cheerful, "Thank you, Miss Manning!"

I love this job.

Welcome to a "sho nuff" county hospital. . . . . .sho-nuff and 'bout it 'bout it

So here's the deal. . . .my sister, JoLai, set up one of these blogspot deals a few weeks ago, and I am admittedly biting off her. (Oh. . bite: v. to copy or follow someone's idea.) So yeah, I'm biting. . . . wait, not completely. I admit that I have toyed around with the thought of some kind of blog or online journal- especially about my experiences surrounding Grady Hospital. So it's a quasi-bite at best off of JoLai, but I can definitely say I was 100% nudged to do this by her doing it first.

So this blog is about my life at and associated with Grady Memorial Hospital. Grady Memorial Hospital (a.k.a. "The Gradys") is a fire-breathing dragon of a county hospital located in the heart of downtown Atlanta, Georgia. When I finished my residency and chief year in combined Internal Medicine and Pediatrics back in 2001, I knew one thing for sure. I knew in my heart that I wanted to go work in the trenches at one of the "sho-nuff" county hospitals. Okay, so what makes a "sho-nuff" county hospital? It's pretty simple. Two things: poverty and pathology. And not just "my lights got turned off this month" poverty. . . . but the searing poverty that exposes you to the extremes of disease and the social aftermath that both precedes and follows it. I always thought working in hospitals like this would feel more like a ministry than a job. And now I can personally attest to this. Bellevue in New York, Charity Hospital (RIP) in New Orleans, Jackson Memorial in Miami, Cook County in Chi-town, and of course, Grady Memorial in the ATL. All "sho nuff" county hospitals lying on a fault line of poverty and pathology.

Yeah, so quick background is that I am a faculty member at the Emory School of Medicine, and have been since 2001. Emory is responsible for the majority of the clinical teaching and care at Grady, and a part of this responsibility is shared with the Morehouse School of Medicine. (Shout out to the historically black med schools, including my alma mater Meharry and Howard Med!) I teach medical students, residents, and care for patients at Grady on both the outpatient (clinic) and inpatient (folks admitted in the hospital) settings. It's hard work. It's often draining. It can be extremely funny and extremely sad just moments apart. . . . . . and as exhausting as it can be, I couldn't see myself doing anything else.



Grady's where the fun is. . . . at least most of the time. . . .hope you enjoy the ride. . . . .speaking of which- I'd better hit the sack 'cause I have to round at the crickety crack of dawn tomorrow!

P.S. Oh and for the record. . . .I will not be violating patient confidentiality nor will I be looking to paint Grady in a bad light. I love me some Grady- don't get it twisted for a second! So. . . understandably, there can only be so much detail. . . but trust me- every day there is a Seinfeld episode just waiting to happen. Now, good night for real!