A life was saved. Yours. And I was there and involved and there to bear witness to it all.
Yes, I was.
No, it wasn't in that sexy or thrilling way. You know, like the kind where someone tears into the room and dives upon your chest for compressions in a single bound. It was nothing like the ones they recreate for melodramatic television dramas with people running beside fast-rolling gurneys steadying wayward IV poles and charging up defibrillator paddles at the same time.
Nope.
But still. A life was saved. Yours. And I know it was because I was there and have been doing this for a while now.
Sometimes we miss it. Those moments like this one. The ones where just one tiny shift in the path does something game-changing. A teeny, tiny nudge toward a seemingly insignificant fork in the road that moves the patient inches away from a giant cliff. Or maybe not a cliff because those are big and obviously treacherous. This was different. More like a slow, downhill trainwreck.
Yes, that.
See, a student listened to you and then shared your story on rounds. Described what you said in detail and all that had been done. And the way he honored your truth helped me to make sense of your perspective but simultaneously recognize that some aspects of our direction didn't make sense at all. And so, I asked one question. Which led to another question. That became a discussion with the whole team.
"Why is this?" I asked. "This doesn't make sense to me. Does it make sense to y'all?" This is what I asked my team. And yes, I said "y'all" because I think easy and calm learning and working climates help us think easier and take better care of patients like you. Or not even just like you. Like any patient who comes before us. I do.
So that student wrinkled his nose and thought about it. And so did my resident and my interns, too. And, though I could not see myself, I am certain that I did the same. Because it didn't make sense. The path we were on and that you'd been on for months and months did not.
Nope.
We came up with a plan. To bring in a consultant to look at some aspects of your case. The parts that weren't readily explainable by the standard pathophysiology of your working diagnosis. And that--that call? It was a game-changer. It was.
And, I think, it saved your life.
No, not in the fireworks and confetti way. Not like that old TV show "ER" or even the newer ones like "Grey's Anatomy." More like with the subtlety of shaking a tiny shard of glass out of a shoe that could ultimately lead to something bad or even adding a drop of much-needed oil to a bike chain and popping it back into place before the entire thing is irreparably destroyed.
Yeah. Like that.
And I thought about it the whole way home. I thought of you and the story you told and the student who listened and the socioeconomic challenges that you face. I reflected on the barriers all around your care that day and how God let this tiny ray of light slip in. And how all of it working together saved your life. I thought about that for my whole drive. Then the next day, I talked to my student about it and cried right in front of him.
I sure did.
"We don't always get it right," I said in our team room later, "but on some days, we do." And I wanted them to not miss what our team had done. They didn't.
A life was saved this week. Yours. And I was there and involved and there to bear witness to it all. A life just as worth saving as my own. Or any person involved in your care. I am so proud of the care our team gave to you and the privilege we had to be involved. Damn, I am. And no, we don't always get it right. But this time we did.
That's what the elderly lady said to me who'd just stepped onto the crowded Grady elevator to slide in right next to me. Even though the small space was filled with passengers standing shoulder to shoulder, my very pregnant silhouette was pretty hard to miss--even under my white coat. "No, ma'am," I responded cheerfully. "This is number two."
"Boy, ain't it?"
I chuckled at her accurate assessment--one I'd heard constantly throughout my pregnancy. "Yes, ma'am. Boy number two." The elder curled her lips downward and gave her head a smug nod.
The other people riding with us turned in my direction. I could feel everyone surveying the position of my belly to see if they agreed. Another woman looked me up and down and then chimed in. "Oh yeah. That's a boy all day and all night." A few others mumbled in agreement.
And you know? Nothing about this felt intrusive to me. All of it was Grady. So very Grady.
"It's because he's sitting high, right?" I patted the side of my stomach when I said that.
"Yeah. And 'cause your face ain't all splotched up and swoll up neither. Them girls rob your beauty every time." The crowd laughed at the Grady elder's unfiltered honesty even though she didn't mean it to be funny. "But you know you gon' have to turn right back around and try for that girl, don't you? Can't leave it at two boys."
I squinted one eye playfully in her direction. "Look at you already planning the next pregnancy! But no, ma'am. I don't think a girl is in my future. I'm pretty sure we might be done after this little boy joins us."
Her face became surprisingly serious. "Oh, now you need a girl. You got to have one."
"Uhhhh. . ." I let out a nervous laugh. Then I decided to break it up with a joke. "Can't you see I cut all my own hair off so I wouldn't have to comb any heads in the morning? God knew what He was doing. He knew I needed boys."
She still wasn't smiling. "Well. You gon' get old one day. It ain't got nothin' to do with buying baby dolls or combing hair. It's your girls that grow up to be the ones that see about you when you old. Even the boys that love they mama ain't no count when you get up in age and need 'em."
Yikes.
The rest of the passengers seemed to conveniently become silent. Even though I didn't want to do it, I started sifting through my head to see if her statement held any truth. Immediately, I imagined my brother, the one who lives only four houses away from his mother--and before that was only separated from her by two houses. "My brother sees about my mother. That's not always true."
"Yo' brother married?"
I swallowed hard and wished the elevator ride would end. Her sustained gaze over the top of her wire glasses was intimidating. I couldn't think of any witty comeback so just answered her question. "He is."
"And I bet she be the one seeing 'bout your mama. I bet."
Just then I was relieved to hear the elevator ping on my floor and the doors fling open. "Well. I hope that's not true of my boys." I offered a tight-lipped smile and eased my protuberant tummy around the crowd. "Have a good day, everybody!"
That Grady elder touched my arm and looked into my eyes. Her entire hand was splayed over my the shoulder of my white coat in that way church folks do when laying hands. "God bless you and your baby, sugar. Speaking health and wellness over you and a easy delivery. In the name of Jesus!" Others in earshot joined in as an amen choir. Just when I started feel a sweet wave of emotion, she added a sucker punch. "And go on have you that girl after this one, hear? For when you get to be a old woman like me. You gon' be glad you listened to me."
I tried to respond with a polite nonverbal expression of gratitude. Mostly I felt this weird mixture of moved, awkward and lightweight offended. Even though I knew she didn't mean it as anything but endearing.
Yeah.
I always remembered what that Grady elder said on that elevator ride. Just as I'd predicted, we were done after Zachary and didn't attempt to have more children. And honestly, I've never really felt much regret about my two boy/no girl household. From the rough and tumble play to the stinky socks to the never-let-down toilet seats, I've loved it all. Truly I have. And sure. I can totally see what is special and amazing about having daughters--especially considering that I am one. But being a boy mama hasn't felt like a mistake or a regret to me. I guess it's just always felt sort of meant to be.
But.
Something about that statement of boys growing into inattentive men who "don't see about their elders" would occasionally niggle at me. Just occasionally. I'd find myself lying in bed cuddling one of the boys and saying things like, "Are you going to forget your mama when you grow up?" Only to feel my heart nearly explode when hearing the heartfelt elementary school declarations otherwise.
I'd still wonder though. In the back of my head, I would.
As silly as it sounds, subconsciously I've kept score ever since. Looking to find as many exceptions to that rule as possible in the family members accompanying in clinic or waiting at the bedsides of my patients. Eyes peeled back looking for those caring, doting, exemplary sons. And yes. There have been sons for sure. But a lot of times there were sisters and wives, too. In fact, nearly all of the times.
So me, the mom of boys, is always hoping, you know? Hoping this isn't how it is. Or, at least, hoping some wonderful women marry my manchildren by the time Harry and I get as old as that woman in the elevator.
Not even kidding.
But, see, that was before I met Mr. Moreland.
I met him in the emergency department one day when my team was on call. He was sitting in the corner with his feet crossed and resting on the edge of the stretcher like it was some kind of ottoman. He was holding on to a folded piece of the Atlanta Journal Constitution and had reading glasses on top of his head. Mr. Moreland stood up the minute I stepped over the threshold into the room. "Frank Moreland," he said shaking my hand. "I'm Mrs. Eloise Moreland's son."
"Nice to meet you, sir. I'm Dr. Manning and I'll be one of the senior doctors taking care of your mother while she's in the hospital, okay?"
"Yes, ma'am," he replied. The "ma'am" felt funny coming from him given that he was easily ten or fifteen years my senior.
Mrs. Eloise had a high fever and a urinary tract infection. Her nearly ninety year old body wasn't much of a match for it, either. She'd been brought to the emergency department confused and moaning. This was a huge change from how she'd been described at baseline.
"Does your mother live alone?"
"No, she live with me." I felt my heart leap a little and scolded myself internally for getting off focus. "She fully self sufficient, though. Real, real independent. She just prefer to not be alone, you know? So she been in my house for quite some time."
"I see. Who else is in the home?"
"It's just me and her. My wife passed a few years back and my kids all grown. But all our family all around so everybody be over there all the time. She got a lot of people looking in on her and coming to see about her."
"That's great."
"Yeah. I'm one of eight. And everybody still living 'cept my oldest sister who passed in '13. I'm the only boy, though." Again an internal pirouette for team boy-mamas.
"Did they used to call you 'brother?'"
"You know it. Still do." He took off his weathered cap and tucked it under his arm with the newspaper. Rubbing his balding head, he yawned. "All them girls and just one boy. That sho' is something, ain't it?"
It was clear that he was exhausted. But interestingly he didn't seem the least bit bitter or bothered by it. And for that, I liked him immediately. I sure did.
For several days I watched Mr. Moreland come and go. One day he'd have a fluffy fleece blanket and another day would be a hot water bottle to put under her neck. And right along with him were those sisters and grandchildren and some great-grandchildren, too. All surrounding their Big Mama with the love and attention she needed to get better. They brought in balloons and cards and rubbed her feet with salve. And all of it was awesome. It was.
But let me be clear. That manchild of hers? He was the one in charge. And Brother was anything but "no count" as my elevator companion suggested. He was conscientious, devoted and there. And it was all so natural. I loved every second of it.
On the day that Mother was discharged from the hospital, I was sitting at the nurses' station writing a note. Mr. Moreland walked up and made some small talk then clarified a few disposition concerns. Just as he prepared to step away, I spoke his name. "Mr. Moreland?"
He turned around with the discharge folder in his hand and raised his eyebrows. "Ma'am?" He never stopped calling me that.
"Can I ask you something? Or rather tell you and ask you something?" He stepped back over to the counter and positioned himself to let me know I had his full attention. And so. I went ahead and told him what was on my mind. I shared with him what that lady said to me ten years before and how seeing him with his mother had given me hope. Then I asked, "What did your mother do? I need to know her secret." I chuckled when I said it although I was only partially joking.
Mr. Moreland narrowed his eyes and sighed. "Oh now it take a village, that's for sure. But my mama loved hard on all of us. Every last one. And I was just the one in the position to move her in with me, you know? I feel sure my sisters woulda done the same. But I had more room and mama got on well with my wife. I guess I ain't never thought about it as strange."
"That lady said I needed a daughter because boys grow up to be no count when it comes to seeing about their elders."
He laughed out loud at that. "I think folk that's no count when it come to their kinfolk is no count everywhere. You ain't got to wait 'til somebody grow old to see that."
"Good point."
"I say just love 'em. Sacrifice for 'em and show them they matter to you. Like they ain't never no afterthought. When they grow up? It won't even call for no arm twisting. It'll just feel like what they 'posed to do. Like it's in order. You mark my words."
"I hope you're right. Because I'm too old to have a daughter now."
"Daughters can be no count, too."
We both laughed. "I loved watching you love on your mama." I felt my eyes starting to sting a little and rolled them skyward. "Ugh. I'm such a mush ball."
Mr. Moreland grinned wide showing the metal dental work along the sides of his back teeth. His face washed over with warmth. "Something tell me those boys of yours gon' be just fine. Don't you worry."
"You think?"
"I'm a son. And I know what it look like when a mama got love in her eyes."
After that, he tipped his cap, turned around and headed back to his mother's room to retrieve the bouquets of flowers, cards and clusters of mylar balloons. I'm super glad he did, too, because I was on the tippy-tip edge of crying. One or two even slid out.
Yeah.
I hope to grow old with Harry and need only love from my children someday. I want them to have full lives of their own. It is also my wish to forge meaningful adult relationships with them and the people with whom they partner. And now, after listening to and watching Mr. Moreland, I recognize that it isn't so much that I want them to move me in with them or deny others for me. I think it's more that I want them to evolve into the kind of empathic human beings that nurture out of love instead of burdensome obligation. And no. Not just toward aging me. But to people in general.
Yeah. That.
Something in my heart tells me that they will.
I'm a mother of boys. And you know? I'm cool with that.
Yeah.
***
Happy Friday.
Now playing on my mental iPod. . . . .
*Names and details changed to protect anonymity. You know the deal.
"I don't come into the hospital a lot." Right after he said that, he pressed down with his hands and scooched his bottom back, trying to get himself comfortable in the hospital bed. I saw an antalgic flash ripple over his face. That fleeting wince told me what I'd come to find out. He was in pain.
Bad pain.
"When was the last time you were here?"
"I don't know. Like maybe six or seven months ago? But it take a lot for me to come up here."
"I hear you."
He was young. Young enough to be my son but old enough to be out of the pediatric setting for his sickle cell anemia. This hospitalization for a vaso-occlusive pain crisis was one of those bread and butter things you see when caring for an urban population. Youngish patients writhing in pain and with high tolerances for pain medications. Ones who've lived so much of their lives in the sick role that it seems to be ground into who they are. That's tough sometimes. And when it comes to any patient needing or wanting or asking for any really, really potent narcotic pain medication, with it comes some skepticism no matter how hard you try.
Yep.
I was back at Grady making rounds late that evening. My resident had asked me to pop in to see him because our pain regimen wasn't quite working. And as soon as I saw him, he quickly notified me that the pain medicine we were giving him was only lasting for about 3 hours.
Yep.
The problem with it was that this was a really strong medication. And giving him even more of a really strong medicine (that is, more frequently) would have put him at greater risk of addiction. And so. I told him just that.
"I worry about giving you this medicine closer together like you're asking. It's habit forming. And one of the most habit forming ones we have."
That's when he just started staring straight ahead, eyes filling up with tears. Nope, not mad. Nope not cursing or yelling expletives either. Just silent and sad appearing.
This was unexpected.
"Sir?" I asked. "I'm sorry. Did I say something wrong?"
He didn't speak back. He just let his eyes rest on the folds of his blanket while blinking back a few more tears. And so. We just sort of sat there for a few moments in this super awkward silence. Him looking down and me watching him.
A nurse walked in and passed a medication. Some kind of pill that looked like tylenol. "How's your pain right now, my friend?" He turned his head toward her and remained quiet. "Okay, sir. I'll let your doctor finish talking to you." And with that she walked on out.
Finally, after what felt like forever, he spoke.
"Doctor?"
"Yes?"
"Do you know what it feel like to be in a sickle cell crisis?"
I swallowed hard, regrouped and thought about his question. But it didn't take long for me to find an answer. "Do I know? No. I couldn't know."
"I'll tell you. It feel like . . . like. . . somebody taking million drills and going in and out of your bones all at the same time. Over and over again. Or like somebody taking the bones in your leg and trying they best to snap 'em in two. Or just putting 'em all in a bag and banging 'em with a hammer until it's nothin' left but dust. And all you can do is just sit there scared it's gon' get worse. And when it finally go away, all you do is pray it don't come back."
I didn't speak. I just listened.
"And you know, Miss Manning? I think that's what have so many people messed up. They don't want that pain coming no where near them. So they ask for more and more medicine 'cause they . . they like. . .traumatized, you know?"
I nodded. "Hmmm."
"But me? I do feel scared of that pain a lot. I do but if you look in my chart, you can see that I don't be up here like that. I try to manage it best I can at home, you know? And when it's real bad, like real, real bad--I come to the hospital."
"I get it."
"But it make you hurt even more to have your doctors looking at you like you some kind of drug fiend. And all I'm telling you is two things: Number one is. . . .I'm me. It ain't nothing in my chart to make somebody think I'm trying to game somebody to get high. But the other thing is that. . .like. . .until you know what if feel like to have somebody break all your bones at once? Cut them folks some slack, man. 'Cause a lot of us be running scared. Scared of that real Boogey Man that's been chasing after us since we was too little to even understand it."
I blinked a few times and let his words sink in. I nodded my head and leaned forward in my chair. "I appreciate you giving me that perspective. I really do. I don't think I'll ever think about sickle cell the same way again.
And I said that because it was true.
I can't imagine what it would be like to have a real, true Boogey Man chasing after me for my whole life. And I especially can't wrap my head around what it must be like to have him catch you repeatedly. In those few moments, that patient gave me a new empathy for those under my care living with sickle cell anemia.
Yeah.
And so. I reviewed his chart. I looked at what he was taking and at all of his numbers. I blended that with his physical examination to guide my clinical decision making. I modified his medication. We talked about his concerns and my concerns and formed a therapeutic alliance. And all of it was good. It was.
A few days later, he was feeling much better and was ready to be discharged from the hospital. He was moving around without pain and felt pretty close to himself again. It made me happy to see him smiling on the way out. Sure did.
I said a little prayer for him as he disappeared down the hallway. Wished on a star that the real Boogey Man would stay away. And that his doctors would no longer become the new subjects of his worst nightmares.
"Any man's death diminishes me, because I am involved in mankind; and therefore never send to know for whom the bell tolls; it tolls for thee.” ~ John Donne
It has now happened to me too many times to count. A person comes into the hospital. Our hands touch at that first meeting and our hearts connect. No, not just in some obligatory way that gets outlined in that first year med school lecture about "BEING EMPATHIC." But more in a natural way. The kind that happens when you strip down the armor of stoicism and reveal a piece of who you truly are.
Yes. So this happened to me this week. It did.
From our first encounter, I knew. I knew this patient, this person would leave me forever changed. I inwardly chuckled, knowing that it would be one of those weeks of late departures--not because of neediness on her part but my own selfish desire for more. More while I could have it. More because my patient was preparing to leave. She was.
It wasn't obvious at first. So mostly, it was just her quick wit and wisdom that created this giant magnet to which I attracted. Between laughs and reflections, I'd coordinate her care with the residents and speak to consult teams. And for every single day that she was there, I would round on her twice. First, for logistical things like pain control and management. Then, to simply close out my day. I'd drag a chair to her right side, hold her hand, and soak it in. I would and I did.
On Friday she was slowing down. Together we'd agreed upon a master plan for an intervention the following week aimed at making her feel better. But some piece of me was conflicted. "Is this what you want?" I asked her.
"What do you think?" she said.
"I think I don't want you to be uncomfortable."
"Okay. Let's play it by ear, okay? If I'm not up to it, I think you will know. And I will trust your judgement."
"I will pay attention, okay?"
"You always do, Dr. Manning."
And that was the end of that discussion.
When I stepped into her room yesterday, the lights were off. It wasn't pitch dark, but more filled with shadows and only the morning sunlight. The family was at the bedside and another consultant was there, too. My team walked in and the family, with whom I'd also developed a connection, notified us that she wasn't talking. The pain in their faces grabbed me by the neck and punched me in the chest. And that, coupled with those shadows, was telling. It was.
I went to her. Usually, I offer a subtle hello and fall back when a consulting colleague has come first, but on this day I broke the rules. She was my patient. An urgency was swelling inside of me. Something was telling me, screaming to me--"You will not get a 'two-a-day' today. You will not."
She was looking straight ahead, not speaking but appeared totally lucid. Like all of this silence was voluntary, representative of elevated thoughts and reflections. The first thing I did was touch her hand like always and move close to her face. "Hello sunshine," I murmured.
And just like that, her face erupted into an enormous smile. Relief washed over the family and even the consultant. She was still there. She was. But still. I could feel it. Her hand on this day was ice cold. Yes, her spirit was still warm, but nothing else.
Nope.
I asked her questions about her pain and nausea. She nodded yes and no appropriately and told me how she was. All nonverbal but still fully present. And so. I kept talking to her. And to the family. Fielding questions from them and all the while holding her cold, cold hand.
The consultant slipped out and all that remained was the family, my team, my patient and those shadows. More questions from the family came. Concrete queries that you ask when you love somebody. Love's myopic view doesn't allow for big picture objectivity. Not that kind of love. But what I've learned is that some piece of this love category, that is, the doctor-patient love category, leaves the sliver of insight that gets lost in other kinds of love. And now that I know this, I have to use it. I must.
So, I try. I try to talk but my face. It starts to get boiling hot and those tears. Those pesky tears they pour from my eyes. My voice cracks and I feel her icy hand tighten around mine like a vice grip. She knows. Her clasp stabilizes me. She gives me courage to be honest and transparent. And so I do.
I give her hand an affirming squeeze to let her know I got the marching orders. Then I turn to her daughter. "Tell the family to get here. Get them here. Today. Now. To love on her. Love hard on her like she loved on all of you." And then I started weeping outright. And because she was holding my hand, I couldn't even wipe the tears fast enough since that would have been a two-hand job.
"Love on her," her daughter repeated while holding my gaze. "Love on her."
"Yes. It's all we have. Love is the what."
There wasn't much more to say after that. Our rapport was good and my patient's response was obvious. I leaned in to tell her good bye and asked once more if she needed anything. She nodded yes to pain medicine and no to nausea medicine. "Okay," I told her. "I got you."
And then, just like that, she spoke. "You look so beautiful." Her voice was clear. Nothing garbled or suggesting confusion. Sure, direct, clear. And those words? They were a gift. Not just to me, but to her family. They needed to know that she was there.
Shortly after that, my team left. Sujin, the third year medical student broke down crying and I consoled her in the hall. And my intern Sonali did the same. "Let it hurt. You want to be affected," I told them. "And don't let anyone tell you otherwise." Then, all of us just stood there in quiet awe of the amazing privilege we'd been given as the caregivers to this soul. We sure did.
A nurse saw us walking up the hall afterward. She asked me, "What happened? Did your patient expire?"
I smiled with my red face and snot-filled nose and replied. "No. We are just feeling fortunate to be her doctors. That's what you see." That is exactly what I said. Because it was true.
My patient passed away yesterday. Only a few hours after that encounter. That family got to her and they were all glad they did. Sonali, the intern caring for her, loved her, too, so returned to the hospital. That sweet intern sure did. And all of it was good. It was.
I'm so glad my boundary issues allow me to feel this way. My chest is heaving as I write this, but in the very best way. We are all connected, I think. Being aware of it and surrendering to it is the issue. That's what I think.
Yeah.
During one of our late afternoon handholding sessions, my patient asked me to write about her when she transitioned. I promised her I would. And so today, I honor that promise and also present a piece of her love to you. Because love? Love doesn't expire. And love, my friends, is the what.
***
Happy Sunday. And thank you for Angella for that beautiful mantra that I say or write somewhere nearly every day.
My patient took off her glasses and said, "I can't keep looking through these rose-colored glasses. I just can't."
I was holding her hand and both of us had tears in our eyes. Her body was sick and she knew it. I felt sad because there wasn't any other treatment to offer.
Then, all of a sudden, she looked at me and smirked. "You know what? I just noticed that these ol' glasses of mine really are rose-colored!" She threw her head back and laughed so hard that I did, too.
After that, we just sat in silence. Holding hands, looking out the window, and wishing on invisible stars.
Today I received an email from a former Emory student/resident that was, quite possibly, the single, most moving thing I've ever had written to me or about me in my entire career. I'm busy right now. Just got back on the hospital service. Have been mad at myself about missing personal deadlines on completing a manuscript I need to finish. And dreading the over 15 "strong" letters of recommendation that students are depending upon me to write for their residency applications. This work can be so grueling sometimes. And sometimes thankless, too.
I started out this day feeling frazzled. I rushed the kids all around the house this morning and still got both of them to school just after the bell. (Fail.) After that, I drove to work coaching myself like a good girlfriend, saying things like, "Girl, stop tripping! You are a great mom" and "Oh, come on. You're an awesome doctor." Because, you know? It was just one of those days. I was so turned around at one point that I thought it was Friday. Except it was Thursday.
But then I checked my email. While sitting in my minivan waiting for my son to come out of ultimate frisbee practice and feeling flustered about the things I still had to do once I got home. A simple tap of my thumb and there it was. Waiting on my iPhone like a balm for my soul. On a day that I truly needed it.
As a clinician educator, I have won some really great awards--I'm talking career-defining ones that parents and family fly in to witness. I've also done some cool stuff--from talking to Anderson Cooper on CNN to publishing in JAMA and Annals of Internal Medicine in the same month to even getting a medical blog nod in the doggone Oprah Magazine. But nothing--and I do mean nothing--compares to one individual learner's affirmation that you've had a real, true impact on his or her life and career. It supersedes any trophy, plaque or media attention. My fellow clinician educators (and educators in general) know what I mean.
"It's the end of a love affair. But not just any love affair--like the love of my life."
~ Mr. Caldwell
For as long as he could remember, she was there. From those early days sitting criss-cross applesauce on the porch shelling peas with grandmama, right along with the unmistakeable scent of red Georgia clay was the hint of her presence wafting by with every humid breeze.
"I can't remember a time without that being a part of my life," he said. And when he said it, he looked down at his hands and sighed. "I just can't."
There was a sadness about him. This heavy cloak of melancholy that pushed against the agenda I'd planned before entering the room. See, this was supposed to be a congratulatory conversation. Me applauding his triumphant separation from alcohol.
Yep.
But as soon as I came into that room and laid eyes on him, I could feel it. Yes, this was a good thing he'd done for his health. And definitely, abstaining from Jack Daniels for 16 full months after nearly a lifetime of being his best friend is no minor feat. So, yeah. I had all these lofty plans of shaking his hand hard and telling him how great it was. Reaching out with both hands and staring deep into his eyes to let him know that I meant it.
Because I did.
But. None of that felt right once I actually sat down. His shoulders were curled inward and his expression was lonely. Like some middle school kid chosen last in the kickball lineup, the kind you immediately want to hug and defend. Yes, Mr. Caldwell had crossed the one year hurdle with AA and had the improvements in his health to show for it. But still. He didn't seem happy.
Nope.
I guess I'd sized him up with this assumption of what he'd be like and where his mind should be, you know? Imagining some gum chewing chap with a bunch of AA key fobs proudly telling it on the mountain that he's just taking it one day at a time. I was expecting a testimony of how now even the smell of alcohol makes his stomach turn a little, especially now that he's broken free of that stronghold. But that isn't what I found.
At all.
"You seem sad," I finally said. "Like. . . . what you've done for yourself is so amazing. And you're doing so great, too. But you seem. . . . I don't know. . . sad."
Mr. Caldwell just stared at me for few moments without speaking. Then, instead of saying something in response, he just sighed and shrugged. His lips moved and I think he said, "Yeah" -- but it wasn't audible.
"Is everything okay at home? Did something happen?"
"No, ma'am. Everything fine with my people, Miss Manning. My kids so happy I don't drink no more." When he said that, the corner of the left side of his mouth turned up a bit.
"That's great, Mr. Caldwell!" I did my best to ramp up the enthusiasm to counter his somber mood. It didn't work.
"I'm okay," he finally said. Then, to make sure I knew he meant it, he repeated himself, this time a little more firmly. "I'm okay."
I leaned into my palm with my chin and squinted my eyes a bit. "You know? You don't seem so okay, Mr. Caldwell."
And something about that--my body language and that last statement--unlocked something. I could tell. His eyes focused on mine some more and I could tell he was trying to decide whether or not to tell me something.
"Tell me," I pressed. "Tell me what is making you so sad."
Mr. Caldwell took a big drag of air through his nostrils, closed his eyes and then shook his head slowly. Then he just froze for a beat with his eyes still closed before parting his lips respond. "I . . I just. . . " He sighed once more and went on. "I just miss it is all."
"Miss what? You mean drinking, sir?"
"Yeah. Like, I keep waiting for that point where I lose the taste for it but it ain't never happened. So when I see it or smell it or see folks drinking, it . . .it just. . .I guess it just make me feel sad."
"Hmmm."
"Like. . . you know how when you was little how your main memories are tied to how stuff smell or the sounds you hear? See, that's how it is with me and drinking. Like, I come from a long family of alcoholics. But not fall down drunk and cuss you out alcoholics. Happy, domino and card playing drinkers. Shit talking and laughing. Having fun. But drinking the whole time. Even with kids around."
The image he'd painted was so vivid that I was at a loss for words. He kept going.
"My grandmama and my granddaddy drank a lot. I was raised around them and both my parents died from problems related to drinking. So I know that it's bad for my health which is what got me to quit, you know? That time they kept me in the hospital, I knew I had to quit so I did. But I guess as time go by I'm realizing that just about every memory I have involve either me drinking or being with somebody who was drinking. Going all the way back."
"You know what, Mr. Caldwell? I never thought of it that way." I said that because it was true. "For you, alcohol is like an old friend."
"Naaah. It's even more than that. Alcohol for me? She family. As much a part of my family as anything. Even when I was a kid."
"You started drinking as a child?"
"Naw, not at all. But my auntie'nem used to sit us on the porch and braid our hair down in cornrows. My mama didn't like cutting out hair so us boys always had braids. I'd be sitting right on the step between her legs. Every so often she'd fuss at me or my cousins saying, 'You bet' not knock over my damn drink!'" That made him laugh. But it was fleeting. "It's funny 'cause whenever I smell some gin, I want to cry for missing my auntie so much. That mixed with Newport menthols. And then along with the smell of some collard greens cooking with ham hocks and the sound of somebody cranking a ice cream maker."
And that? That made my eyes sting. Partly because I finally understood what he meant. But also because I knew there wasn't really anything I could do about it. I started to counter him with some canned commentary on the health benefits of no longer drinking but none of it felt right. Instead I just twisted my mouth and nodded. Because I got it.
I put my hand on his and squeezed it. "Thank you for giving me a new perspective, Mr. Caldwell. I get it."
Finally, he let out an unexpected chuckle. "Sometimes seem like the ones you can't get enough of don't love you back, do they? I love her but she don't love me."
"Yeah, she's funny like that."
"But I miss her. Every single day. Even though I shouldn't, I do. And all the people I loved though the years that's associated with her. My whole world different. My whole life different."
"In a good way?"
"I'm alive, which is good. I ain't getting DUI charges, which is good. But just imagine if whatever it is that connect you to all your favorite people, favorite memories and favorite things, you can't do no more. Or if you couldn't be around none of it no more. It's hard."
"That sounds super hard."
After that we just sat in silence. Him looking directly at me, face washed over with this complicated grief, and me squeezing down on his hand with mine. I kept wanting to say something or feeling like I should but nothing was feeling authentic enough. I stayed quiet.
Finally, Mr. Caldwell sighed and gently pulled his hand back. "I appreciate your concern, Miss Manning. I do." He began sliding his papers and medications back into his little knapsack and then pulled the drawstring closed. Patting the bag, he said for closure, "Yeah. So I guess I'm sad 'cause it's the end of a love affair. But not just any love affair--like the love of my life."
"Wow," I whispered.
"Sound crazy, don't I?"
"No, sir. You sound honest."
Yeah.
In the twenty years that I have been a physician, I have asked the same question of countless patients struggling with alcohol use disorders: "Did you grow up with any drinkers?" To date, I have never once heard a response that included anything other than the affirmative.
Nope.
This? Mr. Caldwell's story? It opened my eyes. He taught me a new layer of why it's so hard for people to let go of alcohol. And you know what else? Thanks to Mr. Caldwell, I will never look at alcohol abstention the same way again.
Ever.
***
Happy Friday.
Now playing on my mental iPod. . . .Mariah Carey singing "Can't Let Go." Because sometimes, even though you try, you can't let go.
It was wonderful and ordinary. Me, sitting on that little couch in their office and them talking to me from their desks. I had a paper in my hand filled with my thoughts on something and I needed their input. And nothing about that was unusual.
Especially this year.
"What do you think about this?" I asked. "Or wait a minute--what about that?"
And, like always, first we looked at each other speaking without talking. Then we all started talking at once yet somehow understanding and hearing what each person has to say. Ideas flying all over the place, crashing into walls, mixing with perspectives and considerations until they meshed into one thing. That's been the nature of this think tank we've developed over the last couple of years. And all of it has been wonderful.
Magical even.
In general, I have a great amount of affection for our Grady chief residents. On most years I befriend them and begin to hammer out ideas with them on things related to our residents and education. They ask for my help on an idea and I ask for theirs. Then, at the end of the year, I feel this slight bit of melancholy at the end of the year, knowing that it's the end of the era. And usually, it's sort of bittersweet but in a way that's mostly okay since that's the way of the medical education world.
Yeah.
But this year is different. The two chief residents at Grady, Jen and Lucas, attended Emory for medical school. I knew them both slightly as students; well enough to be happy when they matched into our program. Then Jen was placed into my Thursday morning resident clinic. I started working with her every single week and got to know her much better. She was also mutual friends with a few of my former small group advisees so the "getting to know you" process was swift and natural. I was immediately impressed by her and wasn't even remotely shocked when she was selected to be a chief resident.
Nope.
And then there was Lucas. I had these smatterings of encounters with him in the clinic and always found his energy positive and infectious. But that all reached a fever pitch when he was assigned to work with me for his first ever senior resident Grady ward month. It was, in a word, awesome. We were drunk with teaching, high on ideas, and manic from the magnetism that we immediately felt as medical nerds. It was indescribably great.
But just when it seemed like it couldn't all get better, I learn that not only will Jen and Lucas be chief residents--they'd be chief residents at the Grady site together. And this meant that all of this energy would be in the office almost directly across from my own for an entire year.
Yes.
We hit the ground running. Since we knew we'd be working together during their chief year, we started our collaboration process during their third year of residency. We hammered out ideas and created curricula. Ran our lecture ideas by one another and offered meaningful feedback. And essentially, pushed ourselves into this amazing zone of development that has lasted for over a year.
Great stuff has come from it, too. Seismic shifts, in my opinion, with the learning climate and the level of expectation our learners have from themselves and their teachers. Out of the box interactive sessions that feel more like a really fun gathering than a mandatory lecture. All a manifestation of what can happen when minds intermingle and ignite one another into being able to do their best work.
So yesterday, I was sitting on that little couch running ideas by Jen and Lucas. We skipped from idea to idea like rocks on a pond, influencing each other and laughing and doing the thing that we've been doing for the last two years. And as I looked at Jen, I noticed all of the words written behind her on the dry erase--board, deadlines, ideas, goals--many of which I sat with them to create. Then in the midst of it all, it dawned on me that it is almost February and that June would be here before we know it. And that, like all of the time I've spent with the chiefs, this time is finite.
Finite.
A wave of sadness washed over me and I quickly coached it away. But right now, I'm feeling it. Feeling it in this weirdly complicated way since the biggest emotion I feel is deep gratitude for this era. But I think that's the hard part, you know? Sometimes you're doing something and you know it's an era. That once it ends it will never be this way again. At least not like this, it won't. And usually that's fine because our lives are enhanced by moving from era to era and the very best ones leave us forever changed for the better--they do. This is no different.
I remember feeling this way around this time during my chief residency. I had this profoundly special mentor named Rick Blinkhorn who was acting as chairman at the time of my chief year. He was smart and innovative and provocative. I loved him in the way you love a cherished mentor because I knew--and I mean it, I was very aware--of how great that era was. I could feel it each day when I met with him and knew I was growing toward something greater because of that time. It was acutely wonderful, that time. It was, and I felt it and knew it.
Yes. That.
Acutely wonderful. I guess that's it. My time working with Jennifer and Lucas in this capacity has been just that. Acutely wonderful. The immediacy of what comes out of our collective thoughts feels magical, not just pleasant. And since I know that it is finite, I feel a little sad about it.
But not so sad I can't enjoy it for what it is and what remains. Plus, I've lived long enough to know how much comes from these times and how much better I am as a result. I'm excited to see that part for us all.
Sigh.
I love that I am a thinker and a feeler. I love that these acutely wonderful eras in my life have been punctuated with chest-grabbing emotion to let me know that this is happening and that I am fortunate. And let me be clear--much of what I do on my job and in my life are perennially pretty awesome. But somehow, some way these moments, that is, the pieces of my life that are acutely wonderful find a way to stand out. They grab me by the waist and pull me close with an outstretched hand to waltz me all around the room in big sweeping circles. And I feel it. And know it. And savor it. I do.
I'm nearing the end of something acutely wonderful and I know it. But you know what? I wouldn't have it any other way. No, I would not.
"Where are you from? You aren't from Georgia," I said. His musical accent was a dead give-away.
"Guess," he replied.
"Louisiana. Totally." We both sat there smiling right after I said that. He then gave me a slow thumbs up and nodded.
"All day and all night, baby."
"Couldn't miss it," I added with a chuckle.
"This accent saved me."
"Yeah?" I raised my eyebrows, intrigued by what I'm sure was a piece of his story. I leaned into my palm and rested my elbow on the desk.
"I came here after Katrina. Didn't have a pot to piss in or a window to throw it out of. And I ain't exaggerating neither, baby. I'm talking the clothes on my back and nothing else."
"Family? Did you have any here?"
"Nope. That's where I ain't like most folk from Looziana. My family small, a lot of 'em out in the country and don't have nothing to help. Plus, I was a city cat, you know? I needed a city. So one of them church groups had a bus coming here and I got on it. Ain't had plan the first of what I'd do once I got here."
"Wow. So how did the accent save you?"
"I was in a shelter. For just one night and it was so, so terrible. Bugs, rats, people yelling and screaming and fighting. Had to get up out of there, baby. I had about forty dollars and blew it all on a cheap hotel room that night. Said I'd get me some rest and then go try to make something happen. Didn't have one dime when I checked out of that room. Not even a bottle of water on me."
"Then what happened?"
"Saw this man with a delivery truck outside of McDonald's. Walked right up on him and said, 'Brother, I need some help. I need to work. Give me a chance and I'll load everything off this truck faster than you can say shrimp etouffe."
And, okay. He didn't actually say "shrimp etouffe" but, admit it, it sounds better for the story.
Anyways.
He goes on to tell me about how the dude at the McDonald's truck said that he wasn't the boss but, like me, heard that sing-song accent and asked him where he was from. And that man said New Orleans and then shared his story. The truck man then took out his cell phone and called up a friend. "My man got this moving company. He could use some good folks to help him." That's what my patient told me the guy at McDonald's told him.
"So the guy hired you?" I asked.
"He had me meet him a few blocks over and said, 'Look, bruh. I'm gon' have you work today and see how it go. If that go okay, we'll go with tomorrow.' And I shook his hand and said, 'Hell yeah, man.' Then I worked my ass off. Moved that shit off that truck in two seconds flat."
"That's awesome."
"It is. Been working with that man ever since. Got me a house and a car and even drive the delivery truck out of state for the company. We doing good, too. Real, real good."
"I love that. Did you ever see the guy from McDonald's again?"
"You know what? Like once or twice. But I told that man that he saved my life. Just 'cause he was interested in the way I talked. Which is crazy because every time I left New Orleans, I used to wish I didn't talk so funny. But now I love my accent. Love it 'cause I know it start up conversations, you know? And conversations lead to relationships. And relationships lead to chances."
I shook my head, then stopped and nodded it hard. "Damn. That's a good word, sir."
"Yeah, it is. It don't take much. What make us feel like outsiders is what open doors to being insiders. Crazy how it all work, ain't it?"
One of my favorite jokes about my husband relates to his meticulous grooming. The man irons everything and, as if that wasn't enough, insists on having his shoes always be as clean as possible. This can mean everything from scrubbing them with a toothbrush and bleach solution to replacing them at a point where nearly all others wouldn't.
Yep.
Harry blames it all on being from the midwest. The Cleveland native in him believes in keeping shoes "fresh" and everything else the same.
Now.
Instead of this translating into reckless indulgence, it is actually quite the contrary. Harry and allegedly all of his midwestern comrades believe in high standards, yes. But they also believe in preservation of what you have. While their trash might look like your treasure, never assume that whatever that thing is was purchased in the last five years. Not when you're dealing with a Cleveland or Detroit native.
Ha.
That brings me to this photo. This is a pair of shoes that belonged to the BHE. They are, quite literally, over ten years old. Harry wore them a great deal back then and, in true Harry form, kept them very, very clean. Eventually they exceeded the limits of midwestern cleanliness and got retired. The best of Harry's sneakers that get put on the bench end up getting saved. A while back I realized that the combination of my husband's well kept old shoe collection and the size of his foot (twelve) was a mighty good thing for a Grady doctor to have in her life. For whatever reason, most of the homeless patients I see who need shoes are a size twelve or less. And are men.
Yep.
And so. On Thursday, my sweet patient sadly told me of his frustrating situation of having only one shoe. And the one he had was on a prosthetic leg which, as Murphy's Law would dictate, was not the same side of the one shoe he did have. Because he didn't want to ruin his expensive prosthetic, he made the choice to go shoeless on his remaining foot to protect the one that he had worked so very hard to get in the first place.
Yup.
"What size shoe do you wear?" I asked.
"Twelve," he replied.
I simply nodded in response knowing what I'd do. And him? He didn't even notice it because this had been his lot in life for some time and never did it even occur to him that the doctor caring for his serious medical problems would also care about him leaving with two shoes.
But I did. A lot.
And so. I brought him some shoes the following day. But not just any shoes. Some shoes that were mostly like new. Shoes so nice that two different people asked me in the elevator what they were for and tried to get me to reconsider "just giving them away" and selling them instead. (Turns out a clean pair of Air Force One Nike shoes is a pretty hot commodity.)
Without question, this was the best part of my day. But not just because of the look on my patient's face when he realized that he'd now have shoes for both feet. . . . it was something more.
"You're giving these away?" he asked.
"No," I replied. "I'm giving them to you."
"But they're so nice."
"You are, too."
And we both smiled at one another for a beat, speaking volumes without saying a word.
Yeah.
The older I get, the more I realize how much life is a continuum. The pieces of our lives in one world intertwined with the other and God somehow offering up these sweet little moments in time where He shows you that all things work can work for good if you let them.
Yeah.
***
Happy Friday. And happy actual birthday, Dr. King.
On my rounds one day, I was with a med student talking to these two women about their seriously ill parent. They were appropriately worried, tired, and understandably nervous. They asked a lot of questions. Tough and skeptical ones, too. And that was fine with me.
It was.
Then, in the middle of my sentence, one sister interrupted me suddenly. "Wait. Can I see your hand?" She turned over my right hand, gasped and then looked over at her sister. "You seethat?"
The other sister smiled and then nodded. "Soror," she said softly, shaking her head and releasing a big relieved sigh. We then embraced in a tight three-way hug. It was beautiful.
My student was so confused. I explained that we all shared the same sorority. "That's so neat!" my student said with a big smile. I could tell, though, that she was still perplexed.
"No, baby," the oldest sister said while tearing up. "This is more than just neat. See, we just found out that we got a doctor in our family seeing about our daddy. Right here at Grady. And when you're worried like we've been? That's a godsend."
And you know what? She was right.
Yeah.
***
Happy Saturday.
Now playing on my mental iPod. I heard this song in my head for the rest of the day, imagining how proud Deanna would be of me and how much she would have loved this photo. I love being a Delta. For me and so many others it's the gift that keeps on giving.
"I remember," she said, "the day when it crossed into something else. Into that freakish range where mothers hiss to their kids to stop staring. At first you think that, just maybe, it's an accident. Then you realize that it isn't. They're whispering and pointing at you."
I squinted my eyes and tried to imagine it. My patient, minding her own business and moving slowly through the aisles of a store. Maybe even doing something like picking up lightbulbs and hand towels in the home improvement section at Target. People walking by and doing those not-so-subtle double takes and her trying her best to not notice it. But she was right. This was more than just a little out of the range of normal. And though I wouldn't choose a word like "freakish" to describe it, I'd be lying if I said that it didn't somewhat fit the definition of that word. Even if it sounds mean to think that way.
Sigh.
Patients like her require special provisions. They bring in a special bed aptly or rather, horribly, referred to as a "big boy bed" to accommodate such a large body. It's hard not to hitch your breath and stare for a beat when you first see her and others of her body habitus. Legs easily larger than my husband's torso and a mid section that appears far to heavy to be supported even by those extremities. The adult in you tries not to see the large pannus lying flaccid over their thighs and fights those silly juvenile thoughts like, "What happens when it's time to go to the bathroom?" or, I'm even more embarrassed to admit, "How would she or he make love? " I timidly raise my hand and admit that I do have these fleeting thoughts. The adult in me flicks them away. But every time, they appear and require that flick.
Yeah.
This encounter with me certainly wasn't helping her self image. My patient had some shortness of breath and was, literally, too big to receive any of the diagnostic studies that we'd considered. She could not have a CT scan. Her circumference exceeded that of the scanner and her weight was more than 150 pounds beyond the limit of the table. A stress test or a even an echocardiogram would be so limited in accuracy that it was almost deemed futile and a waste of her money and time to pursue. And to make matters worse, even if a stress test did find even some equivocal result, the cardiac catheterization lab wouldn't be able to handle 650 pounds on their support structure either.
Nope.
Ever since I was a resident physician in Cleveland, Ohio back in the 1990's, this kind of issue has periodically come up. Without fail, no matter where you practice, some well-meaning person speaks of the urban legend of the city zoo being an option. And no, not with cackling mean-person sarcasm but with a full-on, dead serious expression. A medical student looks stunned and queries whether or not a patient can truly go to the zoo for such a thing at which point whomever is speaking affirms it as the gospel. All of it reminds me of those stories of funny names in newborn nurseries, like the woman who named her twins "Oranjello" and "Lemonjello" since that's what they fed her in labor and delivery before she had them. Somehow the mother of those twins has managed to live in Cleveland, Ohio, Nashville, Tennessee, and Atlanta, Georgia. That, or she doesn't exist.
The zoo thing, though, I must admit always intrigued me. So, a few years after I came to Atlanta, I called Zoo Atlanta on behalf of a patient of mine. He needed a cardiac catheterization and I wanted to actually sniff out this trail to see if it truly would lead somewhere. Several of my calls were met with chuckles. Even when I reached some nice tech in the Large Animal area, he notified me that the zoo veterinarians did have X-ray machines and even a cath lab made special for elephants and such, but that actually having human cardiologists come in to use them on humans wasn't something he was aware they did. After that I spoke to our cardiologists who calmly answered me (while staring incredulously) telling me that logistically, it would be too much.
"We couldn't really do interventions either, Kim."
"Like place a stent or something?"
"Yes. And even if there was something significant enough for bypass, that wouldn't be an option either. The anesthesia risk would just be too great," the cardiologist said.
"I appreciate you actually thinking this through," I recall mumbling.
"This is really a sad, Catch 22 of a situation. I hate when it comes up."
And that was just sort of where we left that. But some piece of me has always felt this weird mixture of better because I actually checked before and discouraged for the very same reason.
Yeah.
So the truth is that, there wasn't anything I could do other than talk to her and listen to her story. And since she'd navigated the last several years of her life as what some would deem a "freak" I just made up my mind to humanize her the best I could.
I noticed her light brown eyes that almost appeared amber, framed with sprawling black eyelashes. She had a dimple in her chin that I thought was cute, whether she was smiling or not. The right cheek had a beauty mark on it, the kind that many women wished for but she'd obviously been blessed with at birth. And her teeth were unusually straight, large and strong appearing. Even though she didn't smile so much.
And so. I listened to her story of the transition from "always a chunky kid" to "overweight" to "really obese" to "freakish." I didn't rush her either. I just sat and paid attention and focused on her lovely eyes, her beauty mark and that cleft in her chin wondering what I could possibly do.
"Those surgeries scare me," she finally said.
"Surgery is a big deal," I replied.
"Yeah. I just feel like it would be such a failure to get an operation just because you couldn't stop eating."
I twisted my mouth and paused before speaking. "Food relationships are complicated. I think of weight loss surgery as an option that is now available that wasn't before, you know? But yeah, surgery isn't something to treat lightly."
"My relationship with food has never been healthy."
"I understand." I wondered if I should say the next thing in my head, but then decided not to overthink it. "I say just look into it. Make a decision after you look into it, you know?"
"Guess I'd not have much to lose, right?" After she said that we both chuckled at the unintended pun.
"Um. . .you could also look into . . . okay. . have you ever heard of this organization called 'Overeaters Anonymous?'" I inwardly cringed when saying the name of it but felt she should consider it. I hoped she wasn't offended. But she shook her head and looked intrigued.
I told her about this 12 step organization that tackled food relationships much like other tried and true organizations helped patients deal with substance abuse issues. And we looked at the website right then and there on our cell phones and she promised me she'd check it out.
And that was that.
We discharged her a few hours after that. Honestly, there wasn't really any more tests I could order and, fortunately, she was doing well enough where most weren't indicated anyway after all was said and done. But I have found myself thinking of her. Pondering her world and that threshold of going from overweight into, to use her words, "freakish." And usually it just leaves me feeling kind of sad.
That is, until this morning when I allowed myself to reflect on what I remember the most about her. Her smile, her enviously stunning eyes, that beauty mark that Marilyn Monroe had nothing on, the tiny indentation in her chin and especially her fearless transparency in describing her life. I realized that this is what I see in my mind when I think of her. And I see that part in greater clarity than anything else.
And that? That leaves me feeling hopeful that at some point something will happen that allows the entire world to see that, too.
Honestly? I write this blog to share the human aspects of medicine + teaching + work/life balance with others and myself -- and to honor the public hospital and her patients--but never at the expense of patient privacy or dignity.
Thanks for stopping by! :)
"One writes out of one thing only--one's own experience. Everything depends of how relentlessly one forces from this experience the last drop, sweet or bitter, it can possibly give."
~ James Baldwin (1924 - 1987)
"Do it for the story." ~ Antoinette Nguyen, MD, MPH
Details, names, time frames, etc. are always changed to protect anonymity. This may or may not be an amalgamation of true,quasi-true, or completely fictional events. But the lessons? They are always real and never, ever fictional. Got that?
