Thick as thieves.

Afternoon with a Grady elder:

Me: "I heard you had a lot of visitors today. I hate I missed them."
Her: "Yeah. It was mostly good."
Me: "Mostly?"
Her: "Mmmm hmmmm."

*silence while watching TV*

Her: "My granddaughter got upset with me."
Me: "Oh yeah? Why?"
Her: "She say I ain't got no business laughing at the TV or at anything else when so much serious stuff happening with my body. She don't like me to be talking about or thinking about anything that ain't concerning my health. She feel like I shouldn't do that."

Me: *just listening*

Her: "Here's what happened: My granddaughter came in here with her friend and her friend just cut her hair all down with some clippers into one of these little afro hairstyles." *pats her head to make sure I understand*
Me: "Wait--what does that have to do with. . ."
Her: "'Cause it look a mess." *laughing hard and smacking the cover in front of her* "Oh Lord. Not cute on her at all. Bless her heart."

*laughter*

Me: "Now that's cold. Did she ask your opinion about her hair?"
Her: "When she came up in my room she did." *laughing even louder*
Me: *shaking my head and trying not to laugh*
Her: "And 'fore you say I got hate in my heart for being black it ain't that neither. Some of these little naturals look real nice. I just don't like it when somebody go and cut they hair off and don't do nothing. Just show up looking like somebody bad ass grandson."

*laughter*

Her: "I want you to pick it or put some pomade in it or somethin'!"
Me: *laughing*
Her: "And then you act like since it's a afro I can't say nothing. That's where you wrong."

*more laughter*

Her: *now serious* "But that ain't what made her mad. It was just that I could laugh period."
Me: "I see."
Her: "And I tried to tell her--'Baby, even when sad and heavy stuff happen 'round you, it don't erase the happy and light stuff.'"

Me: *staring at her*

Her: "Like, if you lose your wife, right? I can tell you I'm sorry and mean it. And then if your little next door neighbor come over and borrow a cup of sugar but want to tell you a joke he heard in school that day, I got it in me to laugh at it."

Me: *still listening*

Her: "I can be sad 'bout your wife and laugh at that joke, too. And it don't make me no less sad 'bout your predicament neither. 'Cawse, see, I think happy and sad--they thick as thieves. So I go on and let 'em live in harmony."

*silence*

Me: "I wish I could record this to play back to myself later."
Her: "Naw. You a good listener. When you listen good, you catch it all."

*silence*

Her: "I don't want nobody turning on they sad on my account. Just be you. If you see me and you feel sad, then be that. But if somewhere in there you got some glad in you, don't go pushing it down on accounta me."
Me: "I love this. Thank you--for real."
Her: "Bet it don't even make sense."

*suddenly I want to cry*

Me: "The thing is. . . it makes so much sense that it makes me want to cry."
Her: "Cry?" *laughing* "Why you want to go and do that?"
Me: "I just feel guilty sometimes. When I feel sad and happy at the same time."
Her: "Don't. Your heart would go crazy if it had to just be one of those all the time."

*silence*

Me: "Do you feel sad about everything sometimes?"
Her: "Sure I do. Sometimes I be in here crying, too."
Me: "You do?"
Her: "Wouldn't you?"

*silence*

Her: "But look here. . . .if you seent that hairdo on that child? Whoooo weeee. You woulda laughed, too. Shit, maybe even cried."

*collective laughter*

Sigh.

My patient was right. I DID listen. And I caught it all. 

Happy and sad are thick as thieves.
And, like her,  I've made up my mind to just let them live.

Yeah.

***
#agoodword #gradyeldersrule #thickasthieves #amazinggrady #loveisthewhat #lettherebelight #andlightenTFupwhileyouatit

Gone to Carolina.

image credit

"Can't you see the sunshine?

Can't you just feel the moonshine?

Ain't it just like a friend of mine to hit you from behind? 

Yes, I'm gone to Carolina in my mind."

For thirteen days straight, I've asked the same questions. "Where are we this morning? Do you know where you are?"

Most days, it's something vanilla like, "We are right here." You point down at the sheets on the bed. "Right, right, here." You look up at me hopeful. And on some days fretful.

"Where is here?" I press.

"Right over here. Not yonder, but here."

Which is technically true. But false at the same time.

Is this delirium or dementia? Or is it both of them stacked on top of one another? Your mental distance is yonder. It saddens me so I keep trying and asking the same questions over and over again. Hoping I'm wrong.

Yeah.

Your family says that you're pretty much "back to how you normally are." And at an age too young to even qualify for Medicare, I wish they were all wrong. So I keep asking.

As of this morning, you were better with regards to what had you hospitalized. Your heart failure exacerbation had improved. The swelling in your legs had dissipated and the oxygen requirement caused by the fluid filling your lungs had waned. From a medical perspective, you could return home. And even though I'd already told your loving family, I still felt the need to tell you, too.

And so I did. You just looked through me with a vacant stare, smoothed out the covers, and sighed. A little hopeful but mostly fretful. I didn't really know what to do with that so I returned to the basics.

"Where are we this morning? Do you know where we are?"

"Oh. We here. We right, right here."

I rubbed your cheek with my hand and smiled."Where is here?"

This time you smiled back. "Greensboro, North Carolina."

My eyebrows raise. This was new, on the last day no less. I'd never heard you say that answer before. Instead of following it up with my standard, "We are at Grady Hospital in Atlanta, Georgia," I left it be. Because this time your eyes were dancing and your expression was so sweet, so innocent.

And, for once, not vacant. Or fretful.

I'd later learn from your daughter that this was where you'd been raised. Milking cows and running through fields with your siblings. The simplest time of your life had been there. Right, right there.

And so. Upon your discharge I left you there. And for the first time since you'd been hospitalized, some piece of me found solace in knowing that you were there. Gone to Carolina in your mind. Instead of here. Right, right here.

Yeah.

***
Happy Tuesday.


Now playing on my mental iPod one of the best songs ever by one of the best artists ever. When I hear it, I will now think of you every time.

Time to Teach.

I don't want to be a human speed breaker--
some wretched intrusion to your hasty departure
from the hospital

I hate imagining that my bright eyes create too much of a glare for you
or that my bushy tail gets in the way of what you have to do
I don't want to think things like that

but sometimes that's how it feels

It isn't my preference to be scuttled off into dusty corners
pseudo-encouraged to explore answers to sidebar questions
that you may or may not even care about

or at least care to hear about from me

It doesn't elate me to be dismissed with the sun still high in the sky
nudged out of the building
but mostly out of your way while you tend to the things
that I long to learn all about

"I wish there was more time to teach," you told me
because if there were you'd show me all kinds of things
and explain more of the nitty gritty of what you're doing

You would but you can't
because there's too much to do and not enough time

Never enough time
especially to teach me in the ways you want to teach me

And so
I sit in the shadows while you scroll through screens
your industrious gaze mostly indifferent broken occasionally by an obligatory smile
then I walk behind you asking the questions 
the ones that I hope might unlock the door and invite me in
into the reasoning, the bedside discoveries, and the sticky conundrums
into the subtle interactions that can and will shape me into a real doctor

But today, you don't because there just isn't enough time
you blanket me with compliments
before sending me in the opposite direction

away from you
away from them
away from the parts I signed up for and always dream of

And yes
I know you wish there was more time to teach me--
the human speed breaker standing between you and "done for the day"--
and yes, I know that you wish you knew what to do with me

But 

You know what I wish?
I wish you knew the truth

that there's always time to teach
and that you're always teaching me

whether you intend to or not

***
Happy Wednesday.

Oh yeah!

Tonight is our 3rd Annual Fellows Teaching Competition at Emory. The Department of Medicine sponsors this amazing event celebrating our dynamic junior teachers--those in fellowship training. Each has prepared an 8 minute lecture that they'll present to a full house and a panel of esteemed judges. The one with the top score takes home a substantial cash prize. Why? Because we want to put our money where our mouth is when it comes to letting our learners and institution know that we value medical education. Every year this event excites us all and reaffirms what those busy days make us forget--that there's always time to teach.

The order of the speakers tonight was selected by the unbiased and sticky fingers of the seven year-old boy pictured below. Oh, and you can read this post to learn more about the Fellows Teaching Competition.

Had to add this. . . .

When you take the time to teach, learners be like. . . .

Sweet basil.

The room was mostly quiet and so were you. Head sinking into the top of two pillows that I personally stacked under your head because it's how you said you liked it. A man was building an herb garden on HGTV over your head and he was really into it.

"There's nothing like cilantro!" he says in this fluffy, tv-man, sing-songy voice. "And basil!" He sticks his nose straight into that finished garden box and inhales an exaggerated breath. "Aaaaah."

With your eyes still on the television you said, "Cilantro. I ain't never been much of a fan of that at all."

And me, I was just sitting on a chair next to your bed that afternoon. Not really for anything necessarily medical but just because you'd been here for some time and it was the only thing in my arsenal of internal medicine tricks that I thought might make you feel better. "Cilantro is like that, you know. There's no in between."

This time you took your eyes off of the television and rested them on me. "What's that you say?"

"Oh. I was just saying that cilantro is one of those things that you either love or you want nothing to do with. When you love it, you can't get enough of it. When you don't, even the smallest piece is too much."

"Yes!" You chuckled at my take on it. You gave your head a hard nod and then repeated yourself. "Yes!"

"You know? Sometimes I think people can be like that."

You were with me. With me 100%. "Like cilantro?" You jutted out your bottom lip and narrowed your eyes. "That's actually kinda deep. But yeah, I can see that. Definitely. Either you can't get enough of 'em or you don't want a thing to do with 'em." You released a soft laugh once again.

"I sometimes wonder what's best. Like, to be cilantro or to be basil. You know?" I really did wonder that. But you had a quick answer.

"I'd say basil. It's kinda pleasant in just about everything, don't you think? But you know it's there."

This time I was the one with the slit-like eyes taking in that analogy. I cocked my head sideways and raised an eyebrow. "Hmmm. But you know it's there. Hmmm. I like that."

After that we sat in silence for a bit. The HGTV man was now on to building a wooden gate for tomatoes. He kept pronouncing it tomah-toes which made us both smile in unison.

You spoke first. "Something 'bout calling it a toe-MAH-toe make it sound better, don't it?"

"I think you're right."

After a few more animated instructions, the show went to commercial. You pulled the covers under your chin and sighed. "I sure don't like cilantro. But I'd take it over radiation treatments any day."

I reached out and squeezed your hand. That was my only response because there wasn't any words for that. Your diagnosis sucks. You getting baked like a casserole every day and being in pain sucked, too. Especially since it was all just for symptoms and not for some foreseeable cure.

You closed your fingers around mine and returned the gesture. Your eyes filled with unexpected gratitude. "Thanks, hear?"

And even though I hadn't seen that coming I knew you meant that-- not for some specific pinpoint thing-- but just for sitting there and not being in a rush. And that made me happy because that was my goal. "I'm glad I'm here," I said.

"Me, too."

"What else can I get for you? What do you need that I might be able to help with?"

You tapped your lip for a second and squinted one eye. "Aaah! I got it. If you see that man building that garden, get me one'a them toe-MAH-toes, hear?" And that made us both laugh out loud. But only for a moment since we both knew that with such low blood counts a fresh tomato couldn't come anywhere near you.

I thought about those big, red tomatoes that the HGTV man plucked off of his homemade fence. I wished I could get you one right that second. I tried to lighten things up some more. "Ha ha. . . those things didn't even look real, did they?"

"Sure didn't, did they, doctor? Looked too good to be true."

Too good to be true.

Something about that statement made my breath hitch and my eyes prickle. I took in a drag of air and stood to leave. "Okay. I've bothered you enough. You try to get some rest, okay?"

You nestled under the blankets and turned on your side to face me. All that I could see was a portion of your nose and eyes and the hairless top of your head. I reached down and tucked you in as tenderly as I could. "You comfortable?"

"Very."

I tip-toed to the door and turned to wave one more time. "I'll see you tomorrow, okay?"

"Okay."

"Alright then, pretty lady."

"Alright then, sweet basil."

Sigh.

I paused with my hand on the handle and then turned to look at you once more. You lifted your chin and moved your smiling face out of the mounds of sheets to let me see your soft expression. And then you closed your eyes and drifted to sleep.

And all I could think was this:

I am so, so glad to be here. Right here, right now. I am. Damn, I am.

Yeah.

***
Happy Thursday.

What lies ahead.

 

An intern on my team was presenting patients to me this morning. I listened to her carefully and watched her mannerisms. She was methodical and thoughtful. So I took it in and got the story that she'd dutifully put together for me to hear.

Then when we went into the room, I noticed her body language. Mindful of the human being before her in this vulnerable position. Eyes on the patient and not darting from side to side. Gently nodding and intentional in demonstrating how much this patient deserved her undivided attention.

It was beautiful.

"Your doctor will tell you the plan for the day, okay?" This is what I told the patient as I stepped aside and allowed her to step forward.

And step forward she did.

Her voice was calm. Each word was laced with such respect that it made me take pause. And the truth is that we had a lot of work to do. A whole lot more patients to go and see on these rounds and, thanks to her and this moment, I recognized that slowing down to fully honor the patient requires a sacrifice that sometimes gets lost. But not on her.

I appreciated the lesson.

I pulled her aside in the hallway later and told her. "I can tell that you deeply, deeply care. It is obvious that you see this as a privilege. It is, you know. Thank you for reminding me of that today."

And her face flushed bright pink because this caught her off guard. But it was true so she needed to hear that.

Here is what I want you all to know:

There are some young caregivers coming along that care. I mean really-and-truly-deep-down-in-their-souls care in the purest and most genuine kind of way. That is what I witnessed on rounds today at Grady Hospital.

And man. I was so glad that I did.

***
Happy Thursday.

(Image above courtesy of Cathy M.)