Reflection of a Former Trendsetter on a Saturday: Slow Motion

*written with patient's permission, but details, etc. changed to protect identity. . . . you know the deal.

No, these Jimmy Choo dandys aren't and won't be my shoe-boots (but the thought of them does make me happy!)

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"Whooooo! I like your boots! Those are hot-to-death, honey-chile!"

I couldn't help but grin from ear to ear at this compliment being paid to me by a pretty stylish, male patient I was seeing one afternoon at Grady. He wasn't being fresh either (or at least it didn't feel that way.) He just seemed to really like my shoes which, I have to say, were some pret-ty special ones. I'd picked them up from Loehmann's a few weeks back, and even though they were a bit trendy, I convinced myself to live a little. The sales lady at Loehmann's told me they would really "pop" with a simple outfit. Something about a shoe "popping" against anything I wore had me sold.

When I came home and showed them to Harry, he (in his brutally honest Harry way) said, "Ehhh." Ehhh? Didn't he realize that these shoe-boots were destined to "pop?" I scrawled on a mental post it note:

Tell Harry that cool person complimented my shoe boots that you described as 'Ehhh.'

My stylish patient folded his arms and jutted his chin out in approval. Take that, Harry. "I'm surprised to see somebody wearing fierce shoes like that in slow-ass Atlanta," he said matter-of-factly. He turned the corners of his mouth downward and shook his head. When I furrowed my brow in response to his mini-jab at the city I now call home, he added,"I moved to Atlanta from New York City, but Lord have mercy! This city is so slow!"

Atlanta? Slow? Really?

"Really? Most of us think of Atlanta as pretty 'big city.' I'd say we're up on the happenings."

My savvy, Gotham City native rolled his eyes and shook his head. "Chile please," he replied with a chuckle, "Y'all are a country-day late and a bumpkin-dollar short!"

Dang.

This patient was interesting. His look definitely gave off a "bright lights, big city" vibe for sure. With neat dreadlocks intricately spun into a crown atop is head and a headband made of some authentic-appearing African fabric, he did make me feel slow. Everything about him seemed worldly and experienced. I felt sure that this was one of those patients who'd been to Iceland, the Galapagos, and Cape Town in his life. Yeah. Just that kind of patient.

His face was pierced--but not in the ways you see every day like above the eyebrow or even the nose or lip. These piercings seemed to be almost hammered into his skull; it wasn't clear to me how or even why they'd been placed in the first place. But this was the kind of patient who would have gladly explained the entire process, if I'd asked. One of those fascinating patients who somehow sucks you into conversations and observations that have virtually zero to do with why they came to the hospital to begin with. My favorite kind of patient, actually.

I decided to go on with the banter. "Well, I'm from L.A., thank you very much, so don't lump me in with your Atlanta insults. L.A. isn't slow."

"Uuuhhhh, I don't know about that one, chile! The last time I was in L.A. it was pretty damn country if you ask me." We both laughed out loud.

"How long have you been here? I mean, in Atlanta?"

"Oh goodness. . . .I've been here for about five years or so. If my sister wasn't here. . . honey-chile, I'd be back in Harlem for sure!" I liked the animated way he called me "chile" and especially his musical "honey-chile." I found it endearing and not the least bit insulting.

"Yeah. . .New York has a great energy. I keep trying to convince one of my friends who used to work with me at Grady to move back here and it's not happening. Guess it's hard to live up to taking your kids to playdates at the Met and the Central Park Zoo."

"Hello?!" He gave me a playful smirk and then smiled wide. "It's like Alicia Keys said. . ." he started snapping his fingers, wagging his head and loudly singing,

"NEW YORK! Concrete jungle where dreams are made of, there's nothing you can't do! Now you're in NEW YORK! These streets will make you feel BRAND NEW, big lights will inspire you!"

I watched him sitting there right in front of me singing boldly like I wasn't even there. Loved it. Especially the finger-popping. He could tell I was fully entertained and stayed with it for a few more beats. Finally, he looked back at me and chuckled again. He was amusing himself, too.

"You've had HIV for some time according to your chart," I spoke getting us back to business.

"Yeah, chile. . . but I am proud to say that I'm undetectable and my T cells are on point!"

T cells on point? Loving this patient.

"What exactly do you mean by 'on point?' I mean, number wise."

He proudly declared in that same musical voice, "Like seven hundred and something? Oh yeah, baby. Magic Johnson ain't got nothin' on me!" He laughed again.

This would be my F.P. (favorite patient) of the day guaranteed. He was being seen for musculoskeletal pain but in no way did any part of his history or physical suggest a septic arthritis. On the review of systems, he endorsed a cough with occasional blood streaks. The fact that he smoked a pack per day made that not such a big deal to me, but that coupled with his HIV status, New York hometown, and travels prompted a colleague to bring him in to exclude tuberculosis. When you work at a place like Grady, TB or not TB is frequently the question (even when it clearly doesn't seem like TB.)

I was glad he wasn't sick-sick. He was so interesting and this would give me more time to talk to him. I wanted to hear his story, or at least part of it. Despite my busy schedule, I wanted to hear his philosophy on a few things and hear him say "honey-chile" a few more times. And that's exactly what I did.

"Do you know how I really knew Atlanta was slow as hell?" he queried with one eyebrow raised. I cocked my head sideways in anticipation of what was sure to be a good answer.

"Crack." He very much caught me off guard.

"I beg your pardon?

"Crack. You know. . . .rocks, base. Come on, chile, don't be slow now!" He threw his head back and cackled.

"No, I know what it is. I meant. . . . like why does crack mean Atlanta is slow?" I was really interested to hear this one.

"Oh crack? Lord, chile, I got down here and could not believe folks was still doing crack down here. Crack? Are you serious? That's so Richard Pryor and 'New Jack City.' I mean, it's like so 1980's and 1990's. Chile, I used to be on that mess. But I started back when nobody understood how addictive it was. I can't believe folks is down here using and selling that mess still. It's so played out. And then folks don't take their HIV meds 'cause they using it, too. Who does that anymore?"

So 1980's. Wow. He made it all so simple. It was like he was talking about bell bottoms or curly perms. "Do drugs 'play out?' I didn't realize they did."

"Crack is played out for sure." He rolled his eyes and waved his hand in the air. "That's why slow cities are the ones with the big crack problems."

"I'm pretty sure crack is still an issue in New York, just like here. Don't you think?" I racked my brain for data on New York and the crack epidemic. It took every bone in my body not to Google it right then and there on my iPhone.

"No way, boo. No way. Y'all Atlanta folks are behind the times. Whitney said, 'Crack is whack.' See what happened with her? That's what happened when she moved to Atlanta, foolin' with y'all and your slow town." There was that infectious laugh again. "Ugggh! Crack? So dated, my Lawd!"

Crack? Is played out? Clearly I'd been caring for a lot of folks who hadn't yet received that memo.

I sat there silently wondering about trends in drug use and trends in general. I thought about how in the last five years, jeans have gone from boot cut, to straight legs to pencil cut silhouettes. I thought about the shoe boots that I had in medical school that I could probably get away with wearing now. I pondered for a moment on the way things go out of style and come back in style. Like skinny jeans (seventh grade, Guess Jeans, oh yeah, baby) and gold hoop earrings (eleventh grade, Salt 'n' Pepa wanna-be, sho nuff!) I found the way he was applying it to the drug thing quite fascinating.

He must have read my mind. "Yeah, everybody in New York is on that retro b.s. now. Can you believe it? Somehow folks got keen on heroin again. Heroin, chile. Can you believe that? They went straight up Billie Holliday, chile. Took it back to the old school. But me? Huh. I had to just keep it Bob Marley. I don't do needles." He shuddered.

I also dug his reference to pop culture in his descriptors of drug eras. "You mean marijuana when you say 'Bob Marley?'"

"Yes, marijuana, chile! What you think I was talking about, Miss L.A.!" He giggled again and gave me a sideways glance. "I don't know, Miss Manning. You might be kinda slow, too."

I drummed my pen on the table for a few moments and looked down at my trendy shoe-boots once again. I thought about the context of this "slow" and smiled. This was a time that I was perfectly fine with being slow and not "popping."

"You know what, sir? Yeah. . . .I guess I am."

Reflection on a Thursday at the Crickety-Crack o' Dawn: Funny the way it is

"Funny the way it is, when you think about it

Somebody's going hungry and someone else is eating out

Funny the way it is, not right or wrong

Somebody's heart is broken and it becomes your favorite song. . . "

from Dave Matthews Band "Funny the Way it is"

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On rounds at Grady one Sunday. . . .

Him: "Miss Manning, I really need you to let me leave the hospital for 'bout five. . .six hours. I promise, I'm gon' come back."

Me: "I don't think it's a good idea. You have too much going on, sir, and something could happen."

Him: "Awwww, ain't nothin' gon' happen. I promise, I said I'm gon' be back."

Me: (considering his drug history) "Hmmmm. . .I really don't think it's such a good idea. Our recommendation is that you stay here to complete your treatment."

Him: "But I must, MUST go. Just for a few hours. Then, like I said, I'm gon' be right back."

Me: "I'm confused. What could possibly be so important that you must leave while being this sick? Maybe we can help you with whatever it is."

Him: "My grandmama sick and she play the organ on Sunday at our church. Some weeks she play and other weeks I play. This her week, and she sick. I need to go play the organ for my church today."

Me: "Really?"

Him: "Yeah, Miss Manning, I promise to God."

Me: "I think it's great that you are looking out for your grandmama and also that you are thinking of your church congregation. But I think they would all want you to stay, too. I bet they would understand that you are too ill to be the stand in."

Him: "But I'm a man of my word. I always told my grandmama that I will step in if it's her week and she can't do it. I gots to go. But, like I said, I'm gon' be right, right back."

Me: (looking at him with hair all over his head, appearing to not have shaved/bathed/groomed for at least 3 months before this hospitalization, and imagining him in a suit playing a lively organ for a Pentacostal church somewhere---uhh. . .no.) "I'm sorry, sir. You would have to leave against our advice."

Him: "But then I wouldn't get no 'scriptions."

Me: "We could probably get you the insulin prescription. Otherwise, it would be against our advice for you to go."

Him: "Insulin? I don't want that. I need my pain medicine, man."

Me: "So stay here with us, sir."

Him: "But I got to, got to go. I'm sayin', though, I promise I'm gon' be right, right, right back."

Me: "No can do, sir."

Him: "But my grandmama and my church is counting on me!"

Me: (thinking of my own church, my down south African-American roots I have in common with this patient, and hoping that my inclination that he really is anxious to use drugs is completely off base) "Sir?"

Him: (looking extremely anxious and now putting on his run down shoes) "Miss Manning, I got to go. I got to go for real before it get too late. Man, my mama sick and my church don't have nobody to play."

Me: "Your mama or your grandmama?"

Him: (stops and thinks for a minute) "Uhhh, my ma- I mean my. . .man, I got to GO!"

Me: "Everyone at your church will be looking for you. Wow, you must have a close knit church."

Him: "Yeah, I do."

Me: "What's your pastor's name and what's the name of your church-home?"

Him: (totally caught off guard) "Huh?"

Me: "Who's your pastor?"

Him: silent

Note: Let me speak on behalf of black people who regularly attend church anywhere in the U.S. but ESPECIALLY in the South. (I feel I have full authority to do so as 1) a black person who 2.) regularly attends church in the South.) If we don't know anybody else's name, we know the name of our pastor. Matter of fact, we know the pastor's name, his (or her) middle initial, the first lady's name, and her favorite color. We might not be able to keep track of all the books in the bible, but our pastor? Chile please!

Ask any black person who attends church this question and it goes like this:

"Do you have a church-home?"
("church-home" is one of my favorite down south references to church membership in the African-American community)

"I attend New Mount Hope Calvary Sermon-on-the-Mount Rhema First Fruits Alpha Omega Missionary Full Gospel Baptist Church where Reverend Dr. Jo-SI-ah Oba-DI-ah MacGriffin is the senior pastor!" (No exaggeration whatsoever.)

Back to my patient. . . .

Me: "I really want to know. . . what's your pastor's name? Surely you know your pastor's name."

Him: "Uuuuhhhh, it's mostly my mama's church and I just be playin' the organ. I don't even be talking to nobody all like that." (He was sinking fast.)

Me: (with light chuckle + hairy eyeball) "Come on Mr. Johnson! You mean to tell me that a brother who must, must, must leave the hospital to go play organ at his church can't even tell me the pastor's full name? Now I know something is fishy."

Him: Sigh

Me: "Look, sir. You are an adult with decision making ability. If you decide to leave, that is your choice. I would not recommend it. Mr. Johnson, I'm worried that your condition could get worse. Sir, I'm also going to be honest and tell you that I'm worried about you leaving here and maybe even using again. . . . .and I don't want you to. I don't. I don't want you to go."

Him: (No longer making eye contact with me) "But, doctor. . . . .I. . .I got to go. I just got to."

Me: "No, you don't, Mr. Johnson. You don't."

Him: (Now looking at me) "But you don't understand, doctor. I do."


And that was that. The patient left against our advice. Remember when I said these conversations start out funny and end not-so-funny? Makes me think of something I've heard the elders say over the years in response to something some might think is funny at first, but really isn't:

"Ha Ha hell."

How funny was it that Mr. Johnson told this colorful tale of urgently needing to play an organ at a church. Problem is that he couldn't recall the church's name or that of its pastor--a fatal flaw in his story that got him busted in a probable fib. Ha Ha. He also has a life threatening condition, is homeless and despite that, left the hospital against medical advice likely to seek something in the streets that he doesn't need. And he will likely be back against his will and maybe without a pulse. Ha Ha hell.

I've thought of Mr. Johnson a lot since he left. While I admit that I was amused by the shakiness of his lie, I'm still saddened by the magnetic pull of something so much greater than the desire to be healthy and safe. I can't prove that it was crack cocaine, but I have been working here long enough to suspect that it was. . . . . .


I wish so bad that I could believe that he really was going to his church. I really do.

I opposite-of-heart crack.

Link to Dave Matthews Band's "Funny The Way it Is"

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)

Everybody has a story. . . .

Ever drive down a major street in a large metropolitan city and witnessed someone erratically walking by with that dazed, drug-addicted look in their eyes? Or better yet, have you ever encountered someone who was giving you this long, drawn out story about how their car broke down, etc. and if only you could give them $5, it would be okay. . . .yet you know from the vacant look on their face that it is likely drugs? Yeah, well if you haven't then just take a trip to downtown Atlanta.

I see so, so many people whose lives have been ruined by drugs, particularly crack cocaine. The most disturbing part about it is that the majority of them look like me- black and female. It really, really sucks. . .and it can be really frustrating at times. But every now and then, I am reminded that every single one of the people I have met or cared for who uses crack cocaine has their very own story.

I was rounding recently and one of my patients, hospitalized for multiple things all of which were complicated by the fact that she was homeless and addicted to crack, had a sad look on her face that morning. When I asked her what was wrong, she gave me a half-hearted smile with a shoulder shrug and told me, "Today is my 30th birthday." Then I noticed this yellow legal pad on the tray table. She had scribbled down all about what she wished this day could be like instead and how much she wished her life could be different. We talked for a while, and I learned a lot about her. Then I thought about my 30th birthday. . . .a fabulous weekend laughing on South Beach with two of my good friends. . . .riding around in a convertible, basking in the Miami sun and sipping mojitos. . . .meeting my best friend, Lisa, in Atlanta afterward for even more celebrating. It was unforgettable.

As soon as I walked out of her room, I burst into tears. That happens to me more often than I should probably admit. (I keep waiting for this point in my career where I will become stoic and unaffected.) Crack cocaine is awful. It is a horrible, ruthless thief that robs young and gifted people of so much promise. And I see it every single day at work. Be glad if it has never occurred to you to try crack, and feel thankful if your family cherished you growing up. If that's your story, count yourself blessed. A lot of folks never even get a fighting chance- and if only they did, they might have gone on to do such great things. The late Keith Haring immortalized this truth in his art (pictured above), and Whitney Houston said it best in her latenight chat with Diane Sawyer- "Crack is wack." Talk about an understatement.


Anyways. . .the next time you see someone who clearly looks like they are "on something" just take a minute to ask yourself. . . "What's her story? How'd he end up like that? What are her talents? What did he want to be when he grew up?" And then, if that's your thing. . . .say a little prayer just for them. I know I do all the time. . . . . .


Like many of my unstably housed patients, this one went back to a downtown homeless shelter when she was discharged. . . . .where a large number of the folks there use crack. Damn.

*patient permission obtained to be subject of blog