I be praying.

"I hope you find your peace, falling on your knees. . . .praying." 

~ Ke$ha

________________________________________

Afternoon rounds with my patient:


Him: "Losing somebody to some kinda accident or violence? That's the worse thang if you ask me."
Me: "You think so?"
Him: "Yeah. Like, you get on with your life and all. But something inside of you gone always stay balled up like a fist. Always."

*silence*

Him: "The problem is that it haunt you like a boogeyman. You be replaying it in your head thinking 'bout what if this or what if that, you know?"

*silence*

After that, my patient started weeping. He turned his head away from me to look at the Atlanta skyline through the window. I sat on the bedside chair, reached for his hand and just held it--gazing at the same view.
Me: *whisper* "I'm so sorry, sir."
Him: *whisper back* "Me, too, Miss Manning."

Finally, he shook his head, let go of my hand and pressed his palms into his eyes. I just sort of watched him helplessly. Because I knew I couldn't take this away from him.

He spoke again.

Him: "I be praying, Miss Manning. I be praying so hard. Asking God please don't do nothing else to nobody. Please God." *starts crying again* "Almost make you scared to love somebody real hard."

*silence*

I wish I could tell you that I said something wise that made all of this better. I didn't. Instead, I just held his hand in silence and coached myself with all of my might not to cry.

It didn't work.


Since I'm a pray-er, before I close my eyes tonight, I will allow my heart to touch and agree with yours. Petitioning God to protect the people we love from calamities and catastrophes. And to fight those lurking boogeymen so that you can finally unclench your fists.

Yeah.

***

Now playing on my mental iPod

The town crier.

"Let her cry. Let the tears fall down like rain." 

- Hootie and the Blowfish

I used to try my best not to cry in front of patients and families. In medical school and residency, I'd excuse myself abruptly and tear out of the room and into a hallway or a bathroom when I felt my eyes stinging. I knew that if I didn't, the volcano would erupt and my secret would be out: I'm a crier.

Yeah.

One day, I didn't make it. I broke down crying while giving some bad news. And you know? The world did not end. I held it together enough to speak in full sentences but, yeah, I cried. Hard, too. And I cried because I was talking about something worth crying about.

Yeah.

Somebody was losing their mama. And that mama was a good mama, too. A sweet, sweet mama. You could see it in the way they rallied around her and rubbed her cheeks and kissed her head. Those grown kids couldn't be objective. Love had them all myopic to how bad this all was.

But not me.

Today that happened to me again. Almost exactly as it did that time many, many years ago. And it happens to me just about every time that I am on the hospital service. I step into the circle of love as one of the only ones who can see. But when they let me in, I start to feel that love, too. I do believe in miracles just like they do. Still, I owe it to everyone to be honest. To tell what I know.

"I don't know what to do," the daughter said.
"I am here to help you be brave," I replied.

And then we both cried. Hard. And I'm crying again writing this.

I'm okay with it, though. When it doesn't hurt is the only time I'll worry. Until then, I'll continue to keep two tissues in my pocket just in case.

Yeah.

***
#thisisgrady #bestjobever #humanityliveshere #letitburn #myteamsawmecrytoo #andiwascoolwithit #amazinggrady #john13v35 #loveisthewhat

A soft place to land.

I saw a grown man weeping the other day. Sitting in his hospital bed, face bathed in the late morning sun rays.  He had clenched his jaw and remained stoic for several days throughout all of this, but finally the reality was too much.

A paper lay on the tray table before him. We'd spoken about that paper at length over the last several days, but today something clicked. Those words typed clearly across the front of it -- Do Not Rescuscitate and Do Not Intubate -- were only in two dimensions but on this day something about them rose up mightily with gnashing teeth in three dimensions.  And despite his prior attempts to avoid it, that 8 x 11 sheet stubbornly awaited his signature. It was the last step before he'd leave for hospice care.

"This means I am leaving to go and die. No matter how I spin it, that's what it means."

And what do you say to that? It was true.  With hospice care, all the focus would be on his comfort and his symptoms. The people there have committed their careers to doing just that, but he was right. Hospice is something for people nearing the end of life.  Yes, he was right.

"I wish so bad that this disease was not trying so hard to shorten your life.  But even if it has its way with the time part, we can win over how that time is spent. We can make that transition easier."

And that's when he did it. He picked up the pen with his hand wobbling and scrawled his signature across the bottom. Done.

The pen fell from between his fingers and his body began to tremble.  Like some kind of volcano he vibrated until hot, fresh tears erupted from his eyes like lava.  Each burst punctuated by baritone moaning; I grabbed his arm and did my best to be of comfort.

And so. I sat there and he wept. Between his sobs he spoke such simple truths:

"I just have so much I still wanted to do."
"I'm going to miss seeing my grandbabies grow up."
"I don't want to go home yet."

But this call was not his to make. It wasn't mine either.

So on this day, I just held his hand and patted his cheeks with tissue. I stared out of the window, marveling at the irony of autumn and the metaphor wrapped into watching seemingly perfect leaves softly breaking away from limbs. Still beautiful enough to stay on trees but for whatever reason have come to the end of their time. Just like those multicolored falling leaves, this decision was out of our hands.

I looked back at him and squeezed his hand tight. It was the only thing I had left.

"We're here for you, okay? We are."

And that was the last thing I said to him that day. Because at this point I knew I couldn't stop him from falling to the earth. But I could at least help him find a soft place to land.

***

Reflection from a Tuesday on the Wards: Let Her Cry

*minor details changed. . . yeah, yeah, you know the deal

"Let her cry. . . .
if the tears fall down like rain. . . .


And if the sun comes up tomorrow,
let her be. . . .let her be."


from Hootie and the Blowfish's "Let Her Cry"

_________________________________________________________

Have you ever been right on the tippy-tip edge of crying but manage to avoid crying by taking a few deep breaths or stopping-dropping-and-rolling before someone hits you with "the concerned look?" Well that's where I was the other day on the wards. Right there. On the brink of a ripple of emotion that could easily be nudged into a tsunami. Fortunately, I was rounding alone that day.

So there I was. . . . just me, my patient's chart, a nurse's clipboard with vital signs and a medication administration record--quietly wrapped up in a cocoon and waiting for these feelings to pass. Stay on task. . . talk to no one. . .write your note. Over and over reciting in my head, Please nobody come up to me. Please nobody come up to me.

No such luck.

From the corner of my eye I saw Ben, one of my interns, walking toward me. Oh no. Please don't start talking to me. No, not now, Ben. Please don't strike up a conversation.

"Hey, Dr. Manning," he said. "How's it going?" Eek eeek eeek.

I offered him a tight lipped smile. Please don't ask anything else. Please don't ask anything else. That's when he hit me with it. "The concerned look" followed by the dreaded "concerned question."

"Uuuhhh, Dr. Manning? You okay?" Damn.

The last sandbag before the levee breaks. . . . . . those two dreaded words: "You okay?" ( The only thing worse is the unsolicited hug.) Anyone who has ever been on the tippy-tip edge of being about to cry knows what happened next. Yup. . . sigh. . . .I started crying. Right there at the chart box in front of my poor unsuspecting, one-and-a-half-month-in intern (who happens to be male.)

Nope. No exaggeration.

Here's the thing: I had just got through talking to my patient and his daughter about his new diagnosis of widely metastatic cancer. One that couldn't be cured short of some divine intervention. In other words, I just told somebody who, just the week before had been minding his own beeswax and living his own life that now all that was about to be cut short. Real short. And that made me sad. . . .

Now understand that this gentleman was pretty up-in-age, but still. Bad news is bad news and like my late grandmother (Mudear) once told me when we sat side by side on a church pew at her younger sister's funeral, "Don't matter how old you get, your baby sister is your baby sister, your momma is your momma and your daddy is your daddy."

And you know what? It wasn't that they didn't take the news so well. Quite the contrary. The patient and his daughter took the news amazingly well. But every time I looked at his daughter (who was in her sixties, by the way) all I could think was, "Don't matter how old you get, your daddy is your daddy." Then I thought about my daddy. I thought about what age would be acceptable to me to hear that kind of news, and thought, um, the age of never. That made my heart swell a bit, but it wasn't even that part that took me to the tippy-tip edge of crying.

It was what this patient said in response to hearing about his diagnosis. This robust, elderly gentleman--I'm talking a gentleman in every sense of the word--sat there on the edge of the bed holding his daughter's hand with his legs comfortably crossed in front of him. She was holding a bible, which, now that I think of it, she always seemed to be holding every time I saw her. Instead of crying, she was looking at her daddy smiling. In fact, the only one who wasn't smiling was me. He looked at me with those wise, octagenarian eyes and said:

"Why you look so sad, doc? Don't be sad 'cawse I ain't sad. Babygirl, let me tell you something. I been here eighty plus years and God been good to me. Good, do you hear me?" (Every time he said "good" he patted his hand on the bed for emphasis.) "I ain't 'fred a no cancer. I done traveled the whole world, known a true love, had some wonderful chil'ren and more grands and great-grands than I can even count. So if cancer is His will for me, then so be it. I'm okay with that. 'Cawse good as God been to me, babygirl, I mean good as He been to me"--(he stopped and shook his head and tapped his foot while his daughter nodded in agreement)-- "The least I can do is accept His will. I mean it's the least I can do in return."

::sigh::

Something about encounters with my Grady patients who have that kind of intrepid faith moves me in the deepest parts of my soul. Problem is, when the deepest part of my soul gets moved, I almost always cry. No matter where I am. And if I'm not careful, it can evolve into "the ugly cry" quicker than you can say "Rumpelstiltskin." That said, I quickly managed to excuse myself from my patient's room to avoid unleashing the tears, let alone the ugly version of them.

"God bless you, sir," I managed to eek out before leaving.

Whew, that was close. I stepped out of the room, into the hallway, and did my best to disappear inside of the chartbox. I swallowed hard and coached myself to not cry--knowing that if I waited long enough, the emotion might just melt away. Unless provoked, of course.

But that's when my earnest, young intern did just that. Strolled up with "the concerned look" and asked me "the concerned question."

"Uuuuhh, Dr. Manning? You okay?" Dang. Here we go. . . . .

Poor Ben. He had to just stand there while I cried. Staring at me with this weird mix of empathy and freaked-outedness. Wondering if he should hug me or smack me. Or both.

Turns out this wasn't the first time this had happened to me. Or the second time even. Once I cried so hard about a patient in front of my resident (now one of our chief residents), Roy A., that I'm pretty sure I scared him. It was pretty mortifying. . . .but that particular day I was so overcome with emotion that I just couldn't reel it in. I know I spent a few days avoiding eye contact with Roy, which as you can imagine, was pretty hard since we were caring for patients together. Later that month he told me that he appreciated how invested I was, and that seeing me cry had taught him something. Roy helped me realize that revealing that vulnerability, especially when you're trying to be a role model, can sometimes can be okay. Actually, more than okay. Sometimes it's necessary.

So thanks to Roy and thanks to the wisdom that comes with time. . . . instead of feeling embarrassed at that chartbox, I saw it as a teachable moment. Allowing a novice physician to witness a more seasoned one humanizing a patient and the family connected to them.

And so sometimes I say forget it and let myself cry. . . managing to keep it two breaths short of the ugly kind. But I don't fight it. I honor what my patients give to me by not fighting it. I honor what this patient is teaching me by not fighting it.

Besides. . . . .it's the least I can do.

Reflection on Thursday: Uploads, Downloads and Hard Drive Reboots

________________________________________________________

Do you ever have periods in your life where you feel like every drop of energy and productivity is being zapped out of you? Like. . . everyone and everything has their USB drives connected to you as their power source, but focused on their needs. . . . . . needs to download from your hard drive, but with very few uploads in return? I mean, I don't think it's on purpose. Sometimes it's the nature of where we are in our lives. People just need you. And while it feels good to be needed, it can be draining at times.

So that's where I'd been fairly recently. Drained. Finding myself stretched in so many directions sometimes that I can feel the seams popping . . . . .resident requirements, student needs, family life. . . . but wait--that's nothing new for me. What, then, makes it now feel so different?

The Difference . . . .

At the end of a particularly long day, I was sitting in the sunroom lounging on the couch. Slightly unusual that I was able to do this considering my kids were not only home, but very much awake. Lately the boys have evolved into being more tandem playmates than parallel playmates. This new arrangement keeps them occupied far longer, and affords me those periodic Calgon moments that used to be no more than fantasy. So there I lay on the couch. . . .mentally recapping my day. . .the highs and the lows. . . .I allowed my eyes to close. Ahhhhh.

"Mommy. Mommy!" I opened one eye and looked at Isaiah, standing in front of me with a Batman costume on. He leaned forward, close enough for me to smell his kid-breath, and repeated, "Mommy!"

"Yes, son. I hear you," I replied while closing my eyes again.

"Mommy, what does 'improved' mean?" he asked.

I rolled over, faced him, and met his eyes. I can always tell when Isaiah really needs my undivided attention. This was one of those moments. "It means you got better at something. Like remember when Mommy used to push you and Zachy in the double stroller, and I would get tired if I tried to run? And then I kept trying until I could run without getting so tired?" He nodded. "That means I improved. I tried and then got better."

Isaiah stood quietly for a moment, looking pensive. "It means at first you weren't doing a good job and then you did better?"

"Ummmm, not exactly," I responded, "It just means your hard work paid off."

"Oh," he answered while still looking concerned. I knew exactly why. Earlier that day, he'd participated in his "graduation" from Pre-K, and upon receiving his "diploma" he also received another special distinction-- "Most Improved."

His teachers somehow decided that all of the kids fell into two categories: "top achiever" or "most improved." Apparently, Isaiah didn't make their cut with the former, and --okay, I'll admit it-- I was slightly miffed. But after a while, I decided that I know my child and where he is cognitively. I decided to let it go. But Isaiah didn't.

"Why didn't everyone get most improved? Didn't everybody learn stuff and then do better?"

"You know what, sweetie? Everyone did learn and do things better. But maybe you did the most better." Most better? Really? I knew how crazy I sounded, and even more, I know my child. He would not buy this reply--no way, no how.

"I don't know if I want to be 'most improved.' Does it mean I had more trouble than them at first?" I sighed hard. Mostly because I didn't know the right answer to these questions, but also because I thought that the award and the very idea of giving such awards to 4 year old kids was complete bullshit. I wanted to look my son squarely in his eye and tell him just that, ending this conversation once and for all. But I couldn't.

Instead, I gently told him about awards and comparisons and how tricky that can be. How even Mommies feel funny sometimes when it comes to things like this, and especially so when it comes to their own children. Then I told him that he was special and wonderful and smart and amazing. He hugged me tight, and, literally, said, "Thank you, Mommy, for telling me that because I think I know a lot of stuff and when you say that it makes me feel proud of myself." Sigh. . .


So now I know what's so different. My children are growing older, and now they need more than just basic care. This, compounded with my professional life, gets pretty heavy at times. The downloads are no longer just diaper changes, cold milk, bubble baths or night time prayers. They now include questions like "what is improved?" or "are you proud of me?" or "why would God ever take a child to live in heaven?" The difference is that these types of downloads require more memory. . .and if I'm not careful to stop for a moment and breathe. . . .my hard drive gets drained and feels like it might crash.

Rebooting. . . .

Lately I've been trying to focus on the uploads and not just the downloads. I'm trying to be present enough to appreciate why those jumpdrives are attached to me in the first place. I've also been trying to slow myself down enough to receive what uploads I may have missed out on before.

A special upload. . . .

On last Saturday, Doug, one of my student advisees, got married here in Atlanta. I have known and advised him since his very first day of medical school, and through our unique curriculum at Emory, have had weekly contact with him since 2007 in a small group with 6 other students. He invited me to his wedding, and (being my perpetually five minutes late self) I managed to slip inside of the church moments before it would begin. Unfortunately, this meant that I was seated away from the rest of our small group, but nonetheless, I was thrilled to have made it just in the nick of time.

First came the organ music, followed by a soloist that sounded like a professional opera singer. This is nice, I thought. But then something happened. Doug entered with his groomsmen and the pastor. The minute I saw him walk in to await his bride at the altar, I felt overcome with emotion. I saw the first day of medical school, I saw the first day of clinical medicine, I saw the countless teaching sessions and mentoring sessions. . . .and somewhere in there, I saw my own sons. I willed myself to keep it together, 1) because I wasn't wearing waterproof mascara, 2) because it would surely lead to the ugly cry, and 3) because I was the absolute only black person there. (I figured that a hysterically crying black woman with raccoon eyes would not be such a good thing at this particular moment. . . .but I digress. . .) And so, this time I did the "pretty cry"-- complete with rapid mascara blotting, upward gazes, and eye fanning.

When the ceremony was over, I joined my student group in the vestibule. Doug walked up, and we congratulated him. It was such a moment, all of us there together supporting him on his big day. I could feel the upload--but just when I thought this was as good as it could get, he looked at me and said with genuine relief in his eyes, "I thought you weren't here. I looked and didn't see you with them, and I said to Anne, 'Dr. Manning. She didn't come. She's not here.'"

Anne touched his arm gently and added, "I told him you were here. I told him Dr. Manning would never miss this." Then she looked at him all new-bride-glowy. "See? I told you, Doug."

I couldn't believe what I'd just heard. That, with as much as he had going on, that he would not only think that, but actually take the time to say it to his new wife during his wedding. I chuckled to break up how intensely moved I was feeling. I looked at Doug and said, "Of course, I'm here, Doug. Of course, I made it."

He smiled and gave me a tight and genuine hug. "I'm so glad you made it, Dr. Manning. I mean that. I'm so happy you are here." And before I could even process the emotion I was feeling, he was whisked away to join his wife and family for wedding photography.

I walked out of the church and sat in my car for a few moments. I thought about how I had been feeling. . .how drained. . .how zapped. . .and then I thought about that moment in the foyer with Doug. It was the most perfect and simple reminder I could have ever been given about why I'm doing all of this. This is why you do this. This is what happens when you let people plug into you. And then I allowed myself to experience it, really experience it. . and then. . .allowed myself to cry. A tired, happy, and fulfilled cry.

Of course I made it.

I'm learning that the very best downloads I can offer don't involve diagnoses, or science, or complicated concepts. They involve relationships. . . . .and most times, just being there. Sometimes it's as simple as rolling over on the couch to face my son . . .and other times, it's just inconspicuously sitting on a lonely pew in a church full of strangers. . .quietly patting the corners of your eyes and wondering why you can't stop crying.

Members of my first small group circa 2010

My first small group as M1 students circa 2007