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

Yes, we can.

mustard seeds

I saw this patient today who was dying. Not dying in the immediate sense where people were running and shouting and drawing up meds and charging up paddles. No, not like that.

But still, he was dying.

Mr. Ward had been seen at another hospital with what he described as a "sour stomach" and "feeling weak." A few tablespoons of baking soda and a little milk of magnesia hadn't helped. Two CT scans and one biopsy later that pain in his stomach proved to be something of much greater concern than the "ind'gestion" he'd initially told them he thought it to be. This was cancer.

Cancer not only in his abdominal cavity but also deep down in his bones. And this kind of cancer is not the kind that can be wrestled to the floor by chemo or pinned to the mat by radiation. At best, those things could keep certain symptoms at bay but, short of a miracle, Mr. Ward was dying.

At this visit, he was joined by his daughter. She looked devastated by the news and he was quiet and peaceful. With glistening eyes, she asked questions about her father's condition. And with each answer, she said, "Thank you, doctor." Even though her mouth was appreciative, her morose expression made it clear that she would rather not hear what we were saying about her father.

But not him. He was as cool as a fan.

"What all y'all got to do to get this on behind me?" he asked matter-of-factly.

"Well," I started, "the best place for us to focus is on how you feel. How do you feel?"

"I feel like I want to get this on behind me. That's how I feel."

His daughter looked at me carefully and then spoke before I could answer. "Daddy, your body is very sick. It might not be that simple."

"What you talking about? Tha's why I'm at the doctor!"

"But Daddy you. . .you have cancer going through your body."

"There you go! Don't be sayin' nothin' to me 'bout that ol' cancer, neither. Look like the minute somebody go and start calling something cancer it jest get worser." Then he turned toward me.  "Jest tell me what all y'all need to do and I'll be there."

"Are you in pain, sir?" I asked.

"I have a little bit of pain on my side. Other than that, I'm alright."

"Okay," I answered. "We can help with that pain, okay?"

"That sound good to me," he replied. He rubbed his thumb across the front of the soiled baseball cap resting in his lap. That hat looked like one he'd worn every single day for quite some time. In red, white, and blue it had big letters sewn into the front:  OBAMA.

I smiled at him and thought for a moment about that hat and the fact that he'd lived to see Mr. Obama take office. Something about that offered me a bit of comfort in the face of all this bad news. I paused, thinking carefully what to say next.

In the silence, his daughter let out a large sigh and straightened up in her chair. Instinctively, I reached out for her hand. She let me.

Something about that gesture struck a cord with Mr. Ward.

"They got a medicine for this, right? I mean, y'all got something that can knock this on out, right?"

"Mr. Ward, sir? We have things to help you feel better. We don't have something to completely make it go away."

Now his daughter's eyes were brimming with tears. He looked from side to side--first at her, then at me, over to her, and back to me.

"Then what do that mean?"

"Every person is different, Mr. Ward. Most people who have this kind of cancer. . .um. . .they. . " Something about the way he was staring at my mouth made me feel nervous about my choice of words. I hated the thought of robbing him of his peace. But I needed to be honest.

Sometimes the easier thing to do is punt the hard questions like this over to the cancer specialists. To simply give the most vanilla answer you can and leave the slow singing and flower bringing to them. And in many instances, when things aren't exactly clear, that's acceptable. But his query was not about five year survival or percentages. It was a simple question to which I knew an answer.

"Mr. Ward, sir?" I exhaled and tried again. "This kind of . . .um. . cancer. . is a kind that works really hard to shorten your life. Even when we fight against it, this particular kind flicks us away like gnats. So a good thing to do is to make sure you feel okay, you know? Like make sure you're not in pain and feeling all bad."

"And jest die?"

I swallowed hard and looked back at his daughter. She decided to help me out. "Daddy, it's all up in your bones."

"Sir, I. . . " The minute I started talking he swung his head back from his daughter to me. Something about the look on his face told me to stop talking.

"What you need to know and you need to know is that that ol' tumor ain't the only thing in these bones, you hear me?" He pointed from side to side at each of us then patted his chest. "Like Jeremiah say, 'It's like a fire shut up in my bones!' I got faith. Even if y'all don't. I got faith in the Lawd and what He can do."

His daughter looked down at her hands like a child. Even though she was easily in her forties, she quickly regressed when her father spoke firmly. Finally, in a tiny voice she pleaded, "Daddy, you want His will. That's what you want. That don't mean I don't have faith, Daddy. It don't."

"Well, you HAVE not 'cawse you ASK not! See, that's the problem with y'all young folks. Yo' faith ain't even like a mustard seed!" He held his two fingers up to demonstrate the minuscule scale of that metaphoric mustard seed. Then Mr. Ward shook his head and then looked back at me. "So when I'm 'posed to see the cancer doctors?"

"Um, you see the main cancer doctor or oncologist on Monday and you have the appointment with the Palliative Care doctors tomorrow."

"What do 'palliate care' do?"

"They focus on your symptoms. Make sure that your pain is controlled and lots of other things."

"Is that the same thang as the hospice?" Mr. Ward asked with eyes narrowed.

"No, sir. It isn't." Which technically was true. At least, sorta kinda.

"Alright then." He slid his tattered Obama cap on top of his head and gave his arms an exaggerated fold. His daughter was staring at him still, her face filled with emotion. Mr. Ward did a bit of a double take and then rolled his eyes. "Come on, here, and finish up 'cawse both a y'all depressin' me!"

We wrapped up the visit and Mr. Ward and his daughter went on their way.

Throughout the day, I thought a lot about Mr. Ward and his take on his diagnosis. I let his words on faith (or even attitude depending on what you believe) marinate with me and wondered where the line should be drawn between that and reality. I still don't know the answer.

Sometimes I find the overly pragmatic patient even more disturbing. And I'm not sure why.

I guess I wrote about this encounter because it made me think about faith and attitude and myself. I say things to people that include "the facts" and have gotten into the habit of habitually buffering it with words like "This is only the information we have available to us medically. There are definitely times--depending upon what you believe--where it becomes clear that we don't have the final say on the outcome."  And that always seems to be met with nodding heads and "Yes, Lords" especially at a place like Grady Hospital. Which always seems to make me feel better about what I'm saying.

But does it really matter how I feel about what I'm saying? My guess is somewhat--but it matters much more how the patient feels.

As far as Mr. Ward goes, that over-worn baseball cap with the 44th president's name embroidered across the front of it seemed to say what he wished I had:

"Yes, we can."

***
Happy Thursday.

He replied, "If you have faith as small as a mustard seed, you say to this mulberry tree, 

'Be uprooted and planted in the sea,' and it will obey you."

~ Luke 17:6

Spirits and Groundhog Day.

*names, deets, all that changed to protect anonymity. . . you know what's up.

"Do you ever have déjà vu?"

"I don't know. . .but I could check with the kitchen!"

~ from the movie Groundhog Day

_____________________________

It had been a long week on the wards. One of those weeks where you round and round on the same people over and over and nothing seems to change. Your medications don't seem to be working, your interventions don't seem to be helping, and your consultants don't have much to add. Yeah. One of those weeks.

The kind of week that just might drive a person to drink. That is, if spirits are their thing. 

Anyways, the worst part of that week was that it always seemed to start and end in the same place--the 5B stepdown unit. This floor was dedicated to those patients who were too sick to be on the regular medical floor yet not quite sick enough for the one-to-one nursing required by the intensive care unit. I had two patients on 5B that week and they were both right on the tippy-tip edge of being just sick enough to be in an ICU. But not quite.

This is what made that week suck.

I love the nurses on 5B, so it wasn't them. I even had love for my two patients that were on that floor. But what I didn't love so much was their ruthless medical problems both of which were alcohol-related.

And these two patients weren't just sick. They were sick-sick. But despite all that, these problems were the kind that, more than anything, were treated with supportive care and watchful waiting. Which after about four days without any improvement whatsoever was getting kind of old.

Oh woe is me, right?

I know. I shouldn't have been complaining about the situation considering I'm the one who signed up to be a Grady doctor, right? But the thing is--the honest to goodness truth--is that this had nothing to do with why they had been hospitalized. No, it wasn't the self-inflicted liquor-thing at all. It's just that. . . .I like seeing people get better. I like seeing them ambulating through the hallways and getting well enough to start complaining about the food. I like when they get to the point of fussing about the poor choices of television channels and leaning over the nurses' station like it's some sort of neighborhood bar.

But these two? They wouldn't budge. No matter what I did.

So every morning, I walked onto the 5B corridor and stopped at Mr. Paxton's room first. He had been admitted for alcoholic hepatitis complicated by alcohol withdrawal. He was mostly somnolent; eyes hidden behind puffy eyelids. In the fleeting moments that his eyes did crack open, the goldenrod hue that had replaced the whites of his eyes revealed the most startling jaundice that I'd ever seen.

Mr. Paxton had decided to stop drinking -- cold turkey. Bad idea considering he'd been drinking for his entire adulthood. Man. That body of his rebelled like nobody's business with seizures, agitation, vomiting and terrifying hallucinations. His blood pressure shot clear up to where they land the Grady helicopters and then his liver went berserk. Totally berserk. 

All of this bought him one day in the Grady ICU but once he was stabilized, he came down to 5B . . . and subsequently my team. Great.

His wife looked tired. I remember how thin and haggard she appeared each day at the bedside and almost every time I secretly wondered if she was just worried or if she, too, had a thing for spirits. I never quite teased out which it was.

Anywho. The day Mr. Paxton came to us was punctuated by the arrival of another man who would eventually become his 5B neighbor--Mr. DiMarco. Like Mr. P, Mr. D had a long, strong history of throwing back stiff ones. He also had a doting wife who consistently sat perched by the bed or who could be found quietly ringing her hands in the family waiting area.

Mr. DiMarco was a lot older than Mr. Paxton. He probably had him by a good twenty years or so, and in those years he'd become set in his ways. Despite a weakened heart from alcoholic cardiomyopathy, he was still unapologetic about his daily drinking.

"Old habits die hard," he said to our team the day we'd met him in the Emergency Department. On second thought he sort of puffed those words because he was so short of breath from his decompensated heart failure.

I remember grabbing Mr. D's wrist while we were talking and feeling his speedy pulse. It was going well over 100 and was what most would describe as "irregularly irregular" -- a term reserved for the erratic rate noted in a type of heart dysrhythmia called atrial fibrillation. Though common in several other conditions, both chronic and binge alcohol drinkers tend to be at risk for this. The problem with atrial fibrillation (or "a fib" as we affectionately call it) is that the blood begins to sludge inside the ventricles from all that catty-wompus beating--which ultimately puts the person at risk for a stroke.

Mr. DiMarco's love for the spirits hadn't made taking medicines--like the ones designed to control his heart rate or the ones for thinning out his blood to avoid blood-sludge--much of a priority. And so. That galloping heart rate in an already pooped out heart made things worse. So we jumped on him full guns blazing--and seemed to be gaining headway after a few hours. That is until someone called us to ask:

"Was he weak on his left side before?"

Shit.

So yeah. Mr. DiMarco with his weak heart muscle and fast heartbeat now had a stroke to boot. Oh, and did I mention? He was a daily drinker so we could count on his body to start withdrawing just like Mr. Paxton's in five, four, three, two. . . .

*beep, beep, beeeeeeep*

Sigh.

So here is the part where medicine gets real. Extremely real. Where all that novelty starts wearing off and reality starts doing more than just kicking in. It starts kicking your behind.

Oh, and these were just two of the eighteen people we were caring for. Um, yeah.

So every day, I'd come and round in the morning on 5B with my team starting with Mr. Paxton. I'd hear what the intern and resident thought and listen to the update on the labs. Then I'd walk in the room with the team in tow and carefully examine him.

First, I'd say hello. No response. Next, a knuckle in the sternum to see if he'd respond. Nada. Unless you count a flash of fluorescent yellow eye-white as a response.

I'd feel his belly and listen to his heart and look for signs of seizure activity. Nothing.

We'd wrap up the plan and head over to Mr. DiMarco's room two doors down.

*ssshhhh, sssshhhh, sssshhhh, ssssshhhh, sssssshhhhh, ssshhhhh*

The sound of every person pushing their hand under the hand sanitizer dispenser followed by a synchronous sound of hands rubbing together that I can't quite describe. Just like before, the first thing would be a greeting. If his wife was there, it would be to her first. And then to him.

"Hey there, Mr. DiMarco!"

*heavy breathing in response*

With the team forming a semi-circle at the foot of the bed, I'd examine him, too. . .periodically glancing up to ask my resident if the Neurology team had any new recommendations for us beyond their initial interventions.

Nope.

So seriously? That week was starting to feel exactly like that movie Ground Hog Day. You know -- the movie where Bill Murray wakes up over and over the same thing keeps happening no matter what. So this was what it was like. No matter what we did each day, nothing changed. At all.

And all because of spirits. Whiskey and bourbon and gin and beer. And sometimes grain.

Spirits.

I would end my day on 5B as well. Hoping that somebody would surprise me by asking me to get them a Co-cola or to even rub some salve on their foot. Something. Anything. But every single day the same thing. Nothing.

On the seventh day, I couldn't take it. The late afternoon sun was beaming through the windows and casting a glare on the electronic medical record. Labs--unchanged. Clinical findings--stagnant. With both patients. After seven days.

Great.

I got up from the nurses' station and slid my coat on. One of my favorite nurses, Ms. Johnson, looked over at me and caught my shoulders curling downward. Next I let out a big, exaggerated sigh and she tenderly said to me, "It's gon' get better, Dr. Manning."

And I looked over at her and then just closed my eyes and sighed again. Because I wasn't sure. Was it going to get better? I mean, yes, technically my week would but would these patients? Would they? The jury was still out on that. On second thought, the jury was about to come to an agreement and I wasn't exactly excited about their decision.

"You know, Ms. Johnson? I don't know what else to do. I'm serious. These two patients just aren't getting any better."

"Well. . .they're not getting worse, Dr. Manning. That's one way to look at it."

"That's not good enough for me. I need them to get better."

Ms. Johnson furrowed her brow and looked over at me as she opened up the tube filled with medications she'd been awaiting from the pharmacy. She shrugged her ample shoulders and raised her eyebrows. "You know what, doc? Sometimes it ain't in your hands."

But this wasn't what I wanted to hear. I wanted my patients to get better. I wanted my hard work and all my fretting and reading and worrying to pay off. So this? This wasn't what I wanted to hear.

"So how do we do this, Ms. Johnson?"  I plunked back down on the seat with my coat on and lay my head into the crook of my arm.

"We just think and try and give our best. But at some point you realize it's something bigger involved in all of it, you know?"

I whipped my head up and stared at Ms. Johnson intently. "Well, this might be one of those times because I'm all spent." I gave a sideways smile and released the world's most anemic chuckle. I hate to admit it, but I was spent. I felt worn out and out of gas. 

"Maybe, Dr. Manning. Maybe." Ms. Johnson stood still; studying me with her wise eyes framed with graying brows matching the crown of silvery curls on her head.

This was feeling heavy. Heavier than I wanted so I tried to lighten things up. I playfully lifted my hands in the air, "Alright, Jesus! I need a consult! An intervention! A somethin'! Come on and help a sista out!"

And Ms. Johnson and I both laughed out loud which lightened things up indeed.

"You want me to put that in the computer?" Ms. Johnson teased as she headed off to administer her medications. I gave her a playful wink, threw my bag on my shoulder and waved goodbye.

"See you later, Ms. Johnson."

Yeah. See you on Ground Hog Day.


The following morning, my resident was in clinic. I'd arrived earlier than normal and decided to sneak by 5B before making work rounds with the interns. The floor was quieter than normal. I attributed this to being the seven o' clock hour unlike our normally later rounding time. I couldn't decide if it was peaceful or eerie. Regardless of which it was, I followed my standard Ground Hog Day ritual. First, I stopped at Mr. Paxton's room.

Hmmm.

Bed one had a lady in it that I didn't recognize. I strolled over to bed two -- his bed-- and froze. Empty.

No, no, no! It can't be!

Recognizing that alcohol withdrawal and alcoholic hepatitis can both be life threatening, I had to know that having them both at the same time could not portend the best of prognoses. But damn. I wasn't expecting Mr. Paxton to be gone. I realized how right Ms. Johnson was when she'd tried to encourage me by saying, "At least your patients aren't getting worse."

Well this was about as "worse" as it could get.

I dreaded getting the details. And even more, my heart began to sink as I imagined looking Mrs. Paxton in her tired eyes. I dragged my feet over to the nurses' station and found a clerk sitting behind a computer.

"What happened to Mr. Paxton?"

The clerk seemed find my anxiety a bit off-putting and didn't hide it one bit. "He's in room 52 now. He got moved," she said nonchalantly. My face washed over with relief and I let out an audible pheew!

I turned toward 52 and paused. Well, this was convenient. He was now in the same room as Mr. DiMarco. Mr. Paxton in bed one and Mr. DiMarco in bed two. Imagine that.

I stuck my hand under the foam dispenser and approached Mr. Paxton's bed while rubbing my hands together. My mouth was already fixed and ready to ask my daily rhetorical question and it came out before I could even take in what he looked like.

"How you doing today, Mr. Paxton?"

And do you know Mr. P was leaned over the tray table circling his choices on the food menu? He glanced right up at me with those canary eyes and replied, "I'm good 'cept for y'all ain't got nothin' for me to eat. What's the RE-NAL DIET? I don't wont this. Or the no salt."

Seriously? I almost leaped on that bed and patted his face. I wanted to squeal with delight but instead kept it cool. "Mr. Paxton, you're talking! I'm so happy to hear you talking!"

And the whole time I examined him, he bitched about that diet and I swear it was music to my ears.

"I'm 'on have my wife brang me some real food up here today. She on her way."

"She is? That's great!"

Mr. P acted like he hadn't been knocked out for seven days and looked at me like I was crazy. "Seem like every channel y'all got is Jerry Spranger or a damn judge show!" he went on.

And that? That really made me want to waltz around his room with him.

Finally, I stepped out of the room to reapply the hand sanitizer before going to Mr. DiMarco's bed. "Well at least somebody has turned a corner," I mumbled to myself while extending my arm. Just as my hand went below the dispenser, I froze in my tracks. . . .recalling the last few words exchanged between Ms. Johnson and me the night before. I could hear her voice like she was right there:

"We just think and try and give our best. But at some point you realize it's something bigger involved in all of it, you know?" 

I nervously pushed the dispenser over and over allowing way to much foam to go into my hand. For some reason, my pulse was quickening and I didn't know why.

What if. . . .? No.

When I stepped around the curtain, the first person I saw was Mrs. DiMarco. Her hand was wobbling and she was carefully scooting a cup of water with a straw in it up to husband's lips. The hairs on my neck began to stand at ninety degrees.

"Good morning, Mr. and Mrs. DiMarco," I spoke quietly.

Mrs. DiMarco looked over at me and smiled sweetly. "Oh hello, doctor," she said with a Kathyrn Hepburn-esque tremor in her voice. Her lips quivered gently as she shifted that smile back to Mr. DiMarco. From the corner of my eye I saw his left hand and arm moving toward the cup.

No. Way.

"He's moving the left side now?" I asked incredulously.

"Yes. It started late last night," Mrs. D responded while still focused on her husband.

"Wow." I couldn't hide my amazement at his improvement.

"Well," she spoke in her bumpy voice, "the Neu-rologists did say that we could start seeing some improvement and that it was just hard to say with all the rum fits and all."

The spirits. That's right.

By my second visit to 5B late that afternoon, those two guys were in there talking crap about the food and the television together. It was unbelievable.

Why they were put in the same room, I have yet to find a solid explanation for it. At least, not one that makes clinical sense. And I promise you--as sure as my name is Kimberly Manning -- this series of events is a true story. Hand over heart.

Okay, honestly? Y'all know I'm a person of faith. I've always been transparent about that among other things when writing here. But this? This shook me to my core. It really did.

"We just think and try and give our best. But at some point you realize it's something bigger involved in all of it, you know?" 

You know? I think Ms. Johnson was right. There has to be something bigger involved in all of it. The human body and healing it is way too complex for it to be just explained by what's in our books. Regardless of what you believe or don't believe or are undecided about how you feel on what that "something bigger" just might be. . . . there are just some things that do not make clinical sense. Changes in patient outcomes that seem to happen almost independently of the things we are doing. Sometimes for the worse. And other times for the miraculous better.

Kind of like this.

No. I'm not saying that what we do medically isn't extremely important. But I am saying that I recognize that I am just a piece in a puzzle. A puzzle that is far more complex than even I understand. And that? That week on 5B? That was about more than just me, man.

At least that's what I believe.

So, this year on Groundhog Day, I guess I'm reflecting on that week on 5B. A week made unforgettable by sick-sick patients and spirits . . . .  of one kind or another.



***
Happy Groundhog Day.

Oh no, I said too much.

"Every whisper. . .
Of every waking hour I'm
Choosing my confessions
Trying to keep an eye on you
Like a hurt lost and blinded fool, fool

Oh no, I've said too much. . ."

~ from R.E.M. "Losing My Religion"

_______________________________________________________

Sometimes patients ask you things that catch you off guard. Things like, "Hey, what race are you?" or even funny ones like, "When's the baby comin'?" when you aren't even pregnant. And sure. Those questions can be both perplexing and amusing at times -- which reminds me-- why is it that only black folks ask (black) me "what are you?" or even why is it that the very day you feel your most sleek and trim post-pregnancy just happens to be the day that some patient winks at you in the elevator and says, "Is it a boy?"

Um, yeah.

But those questions? Those questions are easy. Here's a question that can be a hard one:

"Do you believe in God?"

Or more specifically if you work at a place like Grady Hospital:

"Do you believe in Jesus?"
Now here's the thing: even for folks that have a very clear answer in their head to that question, it isn't necessarily an easy one. It steps into a fuzzy place that sometimes doctors get squirmy in with their patients. That personal space place. That inner thoughts and feelings place. And for some, that flat out none-of-your-business place.

Hmmm.

Today I'm reflecting on this because yesterday I was leading a session with my second year small group students and the topic was "Spirituality and Medicine." Our discussion started off simple enough and then evolved to this one where we got into a very interesting dialogue about how one responds to patients asking questions about your religious beliefs (or lack thereof.)

The students had some interesting perspectives. They represent many different beliefs on a myriad of intensities, so I was keen on hearing their thoughts. One person asked if the best thing to do was to "just tell the person what they want to hear." Another was firmly against that. Some offered thoughtful examples of how they could navigate respecting where the patient was and protecting their own privacy. A few weren't sure what they'd do. And eventually, they asked me what I thought.

members of "Small Group Beta"

Okay. So, I think I am fairly transparent on this blog, or at least I try to be. Most have probably gathered that I am of Christian faith and wouldn't be surprised when I describe myself as observant. Nope, I'm not fire and brimstone. Nope, I don't have flaming stones to sling from my purse or hateful, disgusted stares for boys who hold hands with boys. Nope. I generally stay in my lane when it comes to judging since the whole judging thing is not my lane. I tend to focus more on that whole "love everybody" thing that Jesus was so into.

Anyways.

I don't pretend to be anyone other than who I just described and have what I like to refer to as a "personal relationship" with God. I pray regularly. Some days more than others. And fortunately, since my relationship with God is personal and we know each other so well, my guess is that He's cool with that. Some people fall into this "personal relationship" category, too, but their relationship with a higher power is so personal that chatting them up about it is like asking them about their weight. A major no no.

Though that isn't usually where I am, I do sometimes wince a teeny bit when the topic comes up. Sometimes it's because I am accompanied by someone else. Other times it's because I fear it will take me somewhere I am not sure I want to go with a patient. So, to answer their question, I tell them something that I heard a resident once say on rounds when asked those very questions:

"May I ask a question of you? Can you tell me why it is that you'd be interested in knowing that about me?"

It was one of the most kind replies to such a question that I'd ever heard. This came out of the mouth of a second year resident, too. He softened his eyes and his voice and respectfully countered with this beautiful response. And I meant to say "beautiful" because it was just that.

This resident happened to not be of Christian faith at all. But the answer the patient gave was so endearing. She simply said, "I want to know because I really like you. I want to know that your soul is saved, so that I can be praying for you if it's not."

And he replied, "I always appreciate prayers."

And she simply smiled back and nodded.
I have used a version of this ever since. One patient answered me by saying, "I want to make sure that the doctors caring for me are believers and that they don't think they God!"

I was with my entire ward team that day, and through this insight was able to answer accordingly.

"Ma'am, to be honest, I am of Christian faith. But more important, I certainly do not think that I am God. I also work with a number of wonderful doctors and students--some of whom are of Christian faith and some of whom are not--and I feel sure that they don't think of themselves as God or all powerful either. We just try our best to do right by you and give you our very best effort. That's something you should want all of your doctors to have in common."

And that answer feels good to me because it doesn't exclude or disrespect the scores of colleagues I have that have different beliefs than my own. Particularly when they are present when I'm asked.
Now. I'd be dishonest if I told you that there hadn't been many a time that I'd joined a patient in prayer or agreed to pray for them. In fact, I've closed my eyes and prayed for a patient right then and there at their bedside before. This has depended upon a lot of factors. The relationship I had with the patient, the urgency of the situation, and of course, the wishes of the patient. Other times, those prayers have been uttered quietly at chart boxes or in stairwells. . . oft times the nearest place I can privately reach to interlace my own beliefs with what I can do medically.

I am not sure these answers are the right answers. In fact, somebody reading this is probably saying that they aren't even close to the right answers. I don't know. But here's what I do know: Medicine is about a whole lot more than medicine. And regardless of what you believe or don't believe. . .it involves having some faith. Sometimes in you. Sometimes in your doctors. And sometimes, if that's your thing, in something altogether different.
***
Anyways. That's all I've got today. Happy Wednesday.

Now playing on my mental iPod. . . . .



Losing my religion by REM

Claims adjustment.

*Names, details, etc. changed. . . .you know what's up. . . .

image credit

"I can't take this, Dr. Manning," my resident, Fiona said to me one day near the end of rounds. "This is bordering on abuse. Seriously."

She was referring to the overbearing sister of our patient, Mr. Denton who had been admitted to our service the day before. He had an unfortunate stroke a little under one year ago--very likely as a result of active cocaine use. Up until then, he'd been living on the streets, shackled onto a crack cocaine chain gang that he couldn't escape. A massive brain hemorrhage finally did what no one else could--peel him away from a gripping stronghold that had alienated him from everyone he loved for years.

"What's going on?" I asked.

"First of all, she's yelling at the nurses, the intern, and me. She's demanding all sorts of things and it's just unreasonable. He shouldn't have even been admitted." Fiona sighed and shook her head. "I'm sorry, Dr. M. I'm just frustrated."

"Why the hostility?" I clarified the statement. "I mean from his sister. Where do you sense it's coming from?"

Fiona paused and squinted her eyes. I could tell she hadn't considered that question. "I don't know. I mean, we've been nothing but polite. . .but the minute I suggested that he be discharged, she lost it. She wants to know why we don't have physical therapy in here trying to get him up and trying to walk." She emphasized the word "walk" by furrowing her brow and shrugging her shoulders. Her mounting frustration was evident; a pink flush over her cheeks resembled that of someone who'd just been outdoors running.

This wasn't an unprofessional resident. Fiona was an effective communicator, an empathic caregiver, and a thoughtful leader. Her other strength was that she was an advocate for her interns, students, and the nurses. She wasn't the one to fool with when it came to tongue lashings by patients or their family members.

"How should we proceed?"

"I don't know, Dr. M." she said with a heavy sigh. "I mean, I know this isn't about me, but it's exhausting. I say we go in together, but I'm telling you. . . .it could be ugly."

I nodded and pressed my hand under the hand sanitizer dispenser. I bit the side of my cheek and looked at Fiona with trepidation before opening the door. The thing is, I wasn't sure what to expect. I knew that a resident this strong had given it a college try. I hoped that something with this repeat encounter would be better.

We entered the room to find Mr. Denton lying quietly in bed. His vacant stare and expressionless face were consistent with the regrettable extent of his brain injury. His arms were flexed upward and his wrists downward; his eyes somewhere very distant. It hurt to see.

His sister immediately rose from her chair and walked toward me with a pad of paper. "What is your name?" she asked while positioning her pen. The intonation of her question was confrontational; too much emphasis on the 'what' in that question.

"Dr. Manning. M-A-N-N-I-N-G."

"M-A-N-N-I-N-G?"

"Yes, ma'am. That's correct." I waited a moment while she jotted it down. "I just wanted to come by to introduce myself to you and to examine your brother."

"Well, I need to know why isn't there a physical therapist here working with him? He really needs that. They need to get him up and walking. How can we know if he can or can't walk if we don't try? And nobody is feeding him. How can he get better if he isn't eating?" She moved around his bed, smoothing the covers and fluffing the pillows. She wiped some saliva from his lip and then spoke to him. "Junior, you hungry, ain't you?"

I stood there quietly; my eyes scanned the perimeter of the hospital bed. A bag hung on a pump on the right side of his bed filled with milky liquid. I traced the attached tubing as far as I could until it disappeared beneath the blanket near his torso. There was no point in pulling back the covers; I knew there was a gastroenteral feeding tube doing the work that his brain would no longer allow his esophagus to do.

I finally got to my examination. Mr. Denton's sister folded her arms and stood right next to me during the entire assessment.

The exam didn't reveal anything active. Other than this very sad state that had now become his new norm, I could only admit that I agreed with Fiona's assessment--there was no reason why he couldn't return to the nursing home.

I felt my pulse beginning to quicken as I searched for the right words to begin what would surely be a difficult exchange. "Ms. . . I'm sorry, I didn't get your name?"


"Alicia Mays. I'm his older sister," she quickly answered. "So what are you planning to do? Can we please get somebody in here to help him eat and get him up to walk?" Alicia blotted her brother's brow with a washcloth and then looked up at me.


"Ms. Mays. . . ." I started, "The thing is that. . . .your brother. . . his stroke has really damaged his brain pretty bad. Because so many of his nerves were hurt, that's why, like, walking would be really tough for him. Like the part of his brain that stayed okay is telling the muscles and nerves to tense up, but the part of the brain that got hurt is the part that tells it when to relax. Without both working together, it's hard."


"He's a fighter," she countered. "We ain't afraid of 'hard', are we Junior?" He lay still, without any change in expression.


"I can tell he is a fighter. . . .I mean. . .with such a big stroke, the fact that he . . . I mean. . .I can tell he is a fighter."


"Yeah. He is."


"Ms. Mays, you need to be aware, though. With all he has been through, right now, he seems to be doing okay. There isn't an active problem that we want to keep him in the hospital for. I think we could coordinate some things between our social worker and the nursing---"


"No, he needs to be eating before he leaves. And also to get up and work on his walking. A lot of people use a walker after strokes, so I'm thinking y'all could call somebody over here to get him a walker."


"Ms. Mays. . . .he can't swallow food because he could choke. That's because of the stroke, so I wouldn't expect him to eat other than the tube feeds. With the walking. . . . I just want to be honest. . . .walking may be unlikely, too. The stroke made it hard for him to breathe at first, and his oxygen was really low. That hurt his brain more. . . and. . " I looked over at Fiona who seemed to already be in a wincing recoil. ". . . .and the chance of him recovering to a point of walking and eating is low."

"Oh. Well, that's fine if you think that, Dr. Manning. But we ain't claiming that. My brother will beat this. He's gonna walk out of here and go to get himself a hamburger and fries." She chuckled a rather odd chuckle. "Ain't that right, Junior? We ain't claimin' that, are we? We know the Lord is able."

Fiona looked at me with pleading eyes and also a bit of confusion. This was hard.


"We ain't claiming that." Sigh. I know this phrase well. When you know the souls of black folks like I do, not only have you heard this spoken more times than you can count, you've probably uttered it once or twice yourself.

"Claiming" something means accepting it as so. "Claiming" something releases it into the universe as a possibility or even, a plausible outcome. You see, trusting in God means, as many folks in these parts put it, "claiming the victory" in advance--the victory promised to those who love God--and specifically Jesus.

I've had my share of "claims."

A few weeks ago, we learned that our home address was being redistricted out of the wonderful elementary school that attracted us to our neighborhood in the first place. All hell was breaking loose, and this house that we'd bought at great sacrifice in 2006 was suddenly going to sharply decline in value. But more than that, our kids wouldn't get to go to the school that we've waited, literally, four years to attend. Snuffed out just like that with Isaiah only in kindergarten.

But I wasn't claiming it.

We prayed about it. We went to meetings. We talked to other parents. And at some point, I said to Harry, "I'm not claiming it. Isaiah and Zachary will go to that school. They will." And the truth? It was a long shot. That awesome school is overfilled and the other one we were getting zoned for is underfilled. I knew it wasn't really personal, and that similar things were being proposed all over the county.

I talked to my dad who used to be on the school board in our county when I was growing up, and asked him what the chances were that there'd be a change of heart and we'd get to stay at our school. Based on his experience? Slim to none.

But still. I wasn't claiming it.

Or rather, I wasn't claiming a negative outcome. Now I do admit. . .at some point, I had a bit of a "claims adjustment" and decided that rather than blindly saying I "wouldn't claim it", I'd shift my focus to wanting what was meant to be. Somewhere in all of it, I really, really believed that we'd be okay. Slim chance or not. And as it turned out, the revised zoning kept our address intact.

Faith won.

So I got what she was saying. God answers some pretty tall orders, so who was I to argue with her, especially since I have plenty of my own testimonies? Though my approach wasn't exactly like hers. . .definitely. . .I got where she was coming from.

"Ms. Mays?" I finally spoke. She rummaged through her purse pulling out papers and writing things down as I spoke. "Ms. Mays. . . .this. . .this is not a good situation. And . . .I, too, am a woman of faith . . . .but if you can just listen to me for a moment. . ."

"I'm listening."

"I can only tell you what I know based upon my medical knowledge. Based upon that. . . .your brother's stroke has changed him where for him to walk or talk or eat on his own would be a miracle. And yes, Ms. Mays, miracles take place, they do. But. . . I cannot be dishonest and tell you there is something I can do in the hospital to make that miracle happen right now. But I can make sure the things he needs, he has. I can make sure he is not in discomfort, and I can answer your questions. . ."

In my head, I was thinking that I could and would pray for them, but I decided to keep that to myself.

"This is ridiculous!" she huffed. "Everybody thinks my brother is dead and he AIN'T DEAD!" Her voice rose up and startled me. "He AIN'T DEAD! He's GONNA WALK! He's GONNA TALK! He's GONNA BE ALRIGHT! You AIN'T GOD!!!" She aimed her index finger directly at me with her arm fully outstretched.

My chest was heaving as I sifted my brain for the right words. I needed to wring out my mind to get my emotions in check. "I don't. . . ." I felt my voice getting tiny and wobbly and my face getting warm. ". . I don't think I'm God. I don't."

"Y'all do. Y'all DO, but you AIN'T!" She pointed skyward with her right hand emphatically, the skin below her ample arms shaking. "He's a HEALER, do you hear me? He's a WAYMAKER!!" she bellowed. Just like I didn't like her "what" earlier, this time I didn't like the accusatory tone of her "He." I glanced at Fiona, whose face was now beet red. She almost looked like she would be sick. I turned my attention back to Alicia.

"Ms. Mays. . . . listen. . .I . . .I know who has the final word. . .I do. And if He intends for something more to happen, it will. . .whether your brother is in this hospital or at his nursing home." I abruptly stared at the floor and then looked back up at her. I felt my voice quivering. "And let me tell you one thing for sure. I do not think I am God."

She stared at me intently as Mr. Denton lay with the same blank expression, possibly oblivious to it all. I repeated myself, knowing that I sounded like a broken record . . .I needed to say it again for me more than anyone else. . .my voice almost a whisper, "I don't think I'm God."

The room fell into an awkward silence. I cast my eyes back down toward the linoleum squares below my feet. I could hear the clock ticking, a phone ringing at the nurses' station, and someone chatting in the hallway. Fiona's eyes were glued to her shoe laces, her mouth sealed into a terse line.

Finally, I shook my head and spoke quietly. "Ms. Alicia. . . .I'm so sorry this happened. I. . .I have a brother and. . . I'm so sorry."

Suddenly I heard Alicia quietly weeping. A tired, frustrated, complicated cry. She immediately began patting her eyes with a frayed piece of tissue fished from her handbag and turned away from us. For a fleeting moment I thought she was going to fully break down, confessing how guilty the family had felt for allowing him to be swallowed up by the world. I was sure a story was coming about how the family turned their back on him; unable to peel his fingers away from his crack pipes or their precious treasures that always seemed to disappear whenever he was around. We'd give her knowing nods, hugs even--embracing the pain that manifested as anger and suspicion--letting her know through our empathy that we understood.

But that didn't happen. She regained her composure before it ever had the chance to be lost.

"Just let me know when he will be discharged back to the nursing home," she mumbled while reaching for her cell phone. She refused my desperate attempts at eye contact.

"Ms. Mays, if--"

"Can you just please just let me know when he will be going back to the nursing home?" she interrupted me. "Please."

"Yes, ma'am."

She began dialing her Blackberry, and then paused to dismiss me with eye contact so searing that it immediately made me wish I'd not been looking in her direction. I obediently stepped toward the door.

I stammered as I reached for the handle, "Ummm. . . . .if you have any other questions. . .my name is--"

"Yeah, I got it," she said, "Manning. M-A-N-N-I-N-G."

Words to Live By.

Today I am reflecting on these words:

"By this shall all men know that ye are my disciples; that you have love for one another."

~ John 13:35

::Sigh::

This is actually my most favorite of my two favorite scriptures in the entire bible. No matter what version. It always sounds beautiful and perfect and has become a mantra that I tell my boys and myself often.

My other favorite one is this:

"Search me, O God, and know my heart; try me, and know my thoughts."

~ Psalm 139:23

Here's the thing--it doesn't matter what religion or spiritual path you follow. To me, these words are meaningful and serve as a beautiful guide on a path to authenticity regardless of in whom or what you believe.

The first verse is so perfect in it's simplicity. How will people know who you are and what you represent? Not by what you say. Not by how much money you have. Not by how fancy you dress. Get it? Your "story" is tied up in the way you love. Judgement, mean spiritedness, and narrow views send a mighty message that no amount of straight-laced-ness can camouflage. You can be in church every Sunday, have perfect attendance at your mosque, or keep the sabbath without fail. If you can't figure out how to love--I mean really love--no one will see the light in you. No matter where you think that light comes from.

Get it?

To me, Psalm 139:23 is about "the real you." Kind of like "you can run but you can't hide" from who you really are. (Don't we all feel like running and hiding from ourselves sometimes?) I feel slightly scared when I read it. Search me? Know my heart? Yikes. It's like inviting a spiritual pat-down.

More than anything, it reminds me of how glad I am for grace and mercy. The same God who knows the wrinkled and crinkled me, and who has both tried me and known even my most unkind thoughts, accepts me and loves me anyway.

::Sigh::

Knowing who people are and realizing their shortcomings. . . . .but loving them anyway? Letting love, not piety, be your calling card?

Yeah, man. That's what I'm talking about.

Listen. I'm not there yet. Not even close. But I'm trying, man. These words ground me and get me back on track. As a doctor, as a wife, as a mother, as a friend, as a sister, as a daughter, as an individual. In all these roles, I just hope to eventually have the me on the outside mirror the me on the inside.

I'll let you know how it goes. . . . .

***

What words inspire you?