Bullies and Cool Kids.

*names changed to protect anonymity

"I wish that I could be like the cool kids. 

'Cause all the cool kids they seem to fit in

I wish that I could be like the cool kids

like the cool kids."

~ Echosmith

_____________________________________________

Medicine can be like middle school at times. Much like seventh grade, it's a combination of development, swagger, and perception. The early bloomers ascend to the top while the others settle wherever they can fit. It isn't always fair, actually. 

Someone deems a person "good" which, in the medical field, is like the equivalent of being considered "cool." Sometimes it's a faculty member or a colleague. Other times it's the nursing staff or junior group of admirers. What happens next isn't too far of a cry from junior high. Opportunities come. Shortcomings are quickly forgiven or even not noticed at all. And if a person is in the cool camp, life is good for the most part. 

Now.

In full transparency, I will share that my experience in residency was from the perspective of a person placed squarely in the cool camp. I remember when it happened, too. I was on my very first rotation as an intern and was signing out a late patient to my attending because my co-intern was in clinic. As I reached the end of my oral presentation and marched through the assessment and plan, my attending stopped, cocked his head sideways, and squinted one eye. 

"Remind me of your name again?"

"Kimberly Draper, sir." 

"And Kimberly where did you go to medical school again?"

"I went to Meharry Medical College, sir. In Nashville, Tennessee." 

He jutted out his lower lip and gave me a slow nod. Then gestured for me to carry on with the rest of my plan.  And that was that.

That attending was a key person on the faculty and a program leader. And I could tell that in that little glimmer of a second, he'd sized me up. The rest of our interactions were positive and he always seemed eager to teach me for the remaining time we had together. 

Sure. I worked hard as an intern and took pride in the lessons Meharry had taught me prior to starting residency. But I quickly began to realize that sometimes my lot in trainee life was better because of my position as one of the cool kids. Or rather, the good ones. 

As time marched on, I started to recognize a few other things, too. I started noticing that the cool kids are often privy to some conversations about the not-so-cool kids that aren't so nice. And I guess since I wasn't too cool in middle school, I've always felt a kindred tie to those who haven't been given a golden ticket. For that reason, those mean words always made me uncomfortable. But like any immature person who has found solace in the cool camp, fear of messing up a good thing can be a mighty muzzle. 

This got me thinking about an experience I had in residency. I had a co-intern who'd worked with me in the NICU during our first few months of internship. Sujata (name changed) was this very petite, soft spoken, and nervous young woman of Indian descent. She had a rather thickish accent but mostly it was her apologetic and anxious nature that drew the most attention to her. And that attention wasn't good, either.

Nope.

Sujata and I were on the same team that month and worked shoulder to shoulder on some very sick infants. In our extensive time together, I rapidly discerned that she'd been completely misunderstood. Not only was Suji highly competent, she was also smarter than anyone else working in the unit that month. That said, when the time came for her to defend her management or answer questions, with a tiny shake of her head she'd disappear into soft, mumbling apologies. It was awful.

Suji became my friend that month. Over that year, she looked out for me, too. Whenever I was on call in a unit or a tough rotation, without fail, she'd slide a tupperware dish into the resident lounge refrigerator with "Kim" written on a piece of masking tape stuck on top. Suji knew how much I loved her authentic South Asian cooking and never missed a chance to allow me to try whatever new recipes she whipped up. I appreciated that.  And mostly I appreciated her. 

But.

One day I was hanging out in the resident lounge waiting for sign out. In walks two "cool kid" senior residents, one of whom had already been chosen to serve as a chief resident the following year. Brent, the rising chief, plops down in a chair and groans loudly. 

"What's all that about?" I laughed.

"It's about the painful night I have ahead of me in the PICU." He plunged his hands into his hair and acted as if he was pulling it out. When I wrinkled my nose and looked puzzled, he clarified it for me. "Dude. Did you see who I'm covering tonight? I'm going to be up all frickin' night."

As soon as he said it, I knew who he was speaking about. He was referring to Suji. 

"Maybe she will be sort of helpful, Brent. You never know. . . she's gotten some more experience over these last few months." That's what the other senior resident said which I would have called him defending Sujata but won't since he was cackling the entire time.

Brent squinted his eyes and stared at his co-resident as if he'd just spoken the most asinine words in the world. "Dude. Did you say helpful? Sujata? Phsssssshhh. That chick is like an accessory nipple, man."

That line caused them both to explode in laughter. The other senior. while gasping to catch his breath, howled out loud. "An accessory nipple? What the hell? I don't even . . .bwah ha ha ha ha. . .wait, man. You gotta clarify on that one." He was already doubled over as he probed on this wicked one-liner partly because anyone who knew Brent knew that his quick-witted humor was unmatched--even when he was being mean. 

"Why an accessory nipple?" I asked, trying to look as genuinely perplexed as possible even though I wasn't. I knew that whatever he was getting at wasn't good. So I suppose this was my milquetoast attempt at a quasi-defense.

Brent propped his clogs on the dented up coffee table and leaned back on the chair. He was already chewing a big bite of the apple in one of his hands and nearly spat it all over the room when he added, "It's a perfect description. An accessory nipple is useless and just in the way. And most of the time embarrassing."  

And that? That was all she wrote. The laughing could no longer be contained. Brent literally fell on the floor and his co-senior began running in circles while screaming hysterically. And I just sort of sat there with this weird expression on my face which probably was some bizarre cross between uncomfortable and amused. You know, that way you look when you snicker at something terrible that you see on social media. 

But even worse was the fact that Sujata was my friend. I didn't defend her. I just sat there like someone watching a mugging in the street and feeling too scared to act.

Yeah.

On the way home I thought about the little babies that I'd seen in the newborn nursery with those extra mammary glands or accessory nipples. The parents pointing at the one, sometimes two little brownish peaks and asking if it was some sort of pimple or birth mark and me trying to explain through embryology that it was a "normal variant." Every single time, they'd look at me in horror as I tried unsuccessfully to reassure them about the random satellite teat that their sweet baby hadn't ditched in utero. Yup. Useless and just in the way. And most of the time embarrassing.  Pretty damn accurate description.

And this was the metaphor someone used to describe my friend as I sat by silently and allowed it. I'm still not certain why I didn't speak up, either. I'm ashamed of it even today.

Anyways.

I guess I am thinking about this today because I was talking to Isaiah about bullies yesterday. He asked me if anyone had ever bullied me. Quickly I told him "heck yes!",  reflecting on my awkward middle school years. Then he hit me with another question that got me thinking. "Did you ever stand by and let somebody get bullied without standing up for them?" 

He sort of pulled the wind from my chest on that one because instead of wandering back into high school or 6th grade, my mind squarely landed on Suji and residency. That "accessory nipple" line was one of many very, very mean things I heard about her without defending her. And so. I was honest. "Yeah, actually. I'm not so proud of that either." 

"Were you in 4th grade?" Isaiah pushed.

I twisted my mouth. "Honestly, son? I was a grown up. And some people who thought I was cool decided one of my friends wasn't. I was too scared of not being liked to speak up."

"As a grown up?"

"I know, right? I should have known better."

"Did your friend know that you weren't sticking up for her?"

I hate it when Isaiah's old soul rips the covers off of me. "Um. I sort of don't think so. Which I guess is the part that I've always felt bad about."

"Were you saying mean things about her, too, when she wasn't there?"

"Not so much. But sometimes I laughed."

Isaiah immediately looked disappointed in me when I said that part which sucked. "That's kind of being two-faced, mom." 

"Yeah, you're right. It wasn't cool."

"No, mom. It wasn't." It looked like he felt bad for giving me such a rough time so he added this to make me feel better. "But it's good when you think about something a long time and then realize a better thing to do. Like, now you tell us to always choose kindness."

I smiled. "Yeah. I guess you're right about that. And you know? It's good to let your kids and friends learn from what you did wrong."

"Yup!"

And with that, he ran off to build Legos. 

The part Isaiah isn't seeing is the part of me that now fights for everyone around me to feel like a cool kid--especially my medical students and resident learners. In all these years I've never shaken Brent's stinging words: "Useless and just in the way. And most of the time embarrassing." I don't ever want to feel that way nor do I ever want someone else to feel that way in my presence. Man, I don't.

Yeah.

I've not gotten it all fully figured out. And Lord knows that I still have my days where I don't advocate for folks like I should. But I'm better than I used to be. And what I know for sure is that the real secret to being a cool kid is believing that you don't need to be.

***

Happy Thursday. And hey, Suji? I'm sorry. 

Now playing on my mental iPod. . . . this. . .

and also this. . . . 

As seen on television.

Confession: I don't know what's wrong with you. No. I mean, literally. I really don't. I have examined you repeatedly. I have carefully pored through your labs and your medications. I have spoken to the consultants and reviewed the multiple pictures taken of your various body parts. And still. I am no closer to knowing an answer than I was when I started.

I ride the elevator thinking about you. Maybe this? Oohh! What about that? And then I run to the nearest computer to look it up only to find that, no, your situation isn't consistent with any of those things. That or the fact that somebody else already had thought of that before my elevator epiphany and ran a test already. Which also came back negative.

So here I am. Right back at square one. Five days into caring for you and as perplexed as I was on the first day. And it's not like you're necessarily worse. But still, you aren't better. At all. And me? I like seeing people get better.

No. It doesn't work like people think it does. Or how they show it on television. We don't always know the answer right away. A lot of times we do. But there are definitely times where we don't. Nope. It's not like House M.D. or E.R. And it's not like Scrubs or Grey's Anatomy, either.

(Okay, maybe my team does get pretty close to Scrubs at times, but that's not the point.)

The point is that that guy House on House M.D. strolls right into hospital rooms and effortlessly turns those perplexing patients like you into sexy ah hah moments. Wrinkling his brown and twisting his mouth until suddenly--ah hah--he asks if anyone thought of, oh, I don't know, cyanide poisoning or something. (Because clearly had anyone simply asked about the cyanide leak in that apartment building, they'd have put that all together.) And just like that, he saves the day within the sixty minutes allotted for solving the case.

But Dr. House isn't a real doctor. He just plays one on T.V. And those patients that he sees? With their cyanide poisoning and their acute intermittent porphyria are actors paid big money to put on fake backless gowns and force out real-appearing tears. But you are more than just a real-appearing patient. You are a real person with a real problem. And, so far, I can't solve it. Because I still don't know why you have it or what it is.

Grrr!

These are the times that I wish I didn't care. The days that I wish I was cool with just shrugging my shoulders and saying "oh well!" But, see, I do care. I sure do--and so do a whole lot of other people.

But still we don't know what's wrong.

So now I am about to read some more and think some more about you. I'm going to examine you some more and ask as many smart people as I can about you until someone finally says with twisted mouth and furrowed brow, "Ah hah!"

And just maybe . . . if we pay attention. . .  that smart person will be you. 


Ah hah.

***

Each one. Teach one.

*Details changed significantly to protect anonymity.

Grady Resident's Clinic, July 2011


"Hi, ma'am. I'm Dr. Manning and I'm the senior doctor working with your doctor today."

"Good morning."

"Good morning to you, too. I heard that you had a rash giving you trouble today, right?" She nodded emphatically and rolled her eyes upward. Without me asking, she opened up her gown to show the angry eruption on her chest wall. I slid on a pair of gloves and asked, "Does this hurt?"

"Like hell," the patient quickly replied. "No, like hell-fire."

With the newly minted intern right beside me, I carefully inspected the flaming crop of dewdrop-appearing bumps spread like a linear stripe just below her right collar bone. "Tell me. . . how did this start?" I looked over at the intern whose brow was furrowed and inquisitive. Then I added, "I know you told your doctor all of this already, but I just wanted to hear a little more for myself if that's okay." I turned my head to make eye contact with both the intern and the patient; this was my unspoken way of getting permission to be redundant.

"First . . . .it felt like. . . .like something burned me. Crazy sounding I know. . . but that's how it felt."

"Ummm hmmmm." I folded my arms and kept listening.

"Then yesterday night I looked and this was what was there. Still burning like the dickens, but now with this ugly rash."

I raised my eyebrows and nodded slowly. "You know what, Ms. Fulsome? You do a great job describing what's going on with you. That was really helpful, thanks. If it's okay with you, we're going to just shop-talk for a few seconds, and we promise to explain everything we're talking about. Feel free to interrupt, okay?" She smiled in acknowledgment and helped us as we closed her gown. Next I faced the intern. "Thoughts?"

The intern licked her lips and pressed them tightly together before speaking. Although we'd met in passing a few times when she was a student, this was our first time working together in a clinical setting. Her brand new lab coat issued during intern orientation was blindingly white; her lack of experience had not yet caused it to be otherwise. Her earnest eyes were unspoiled, just like her white coat. . . . but she seemed nervous.

"No pressure, okay?" I offered. "Look. . . I really just want to hear what's on your mind. When we were outside you mentioned a few thoughts, and I was wondering if any other things had come to mind since we came in here together."

"I guess my first thought was pretty off then." She laughed nervously and then continued. "I was thinking that maybe. . . maybe she came in contact with something? Maybe poison oak or poison ivy? Especially since it is so linear?"

"Good point. Contact dermatitis from poison ivy can definitely give you blisters and you're right, it's one of the only things that gives you straight lines." I gently re-exposed the rash while being careful to keep Ms. Fulsome's breast from being exposed with the other. "This looks less like straight lines per se. . . and more like . . . . blisters on a red base. . . . but limited to one area. Kind of sparing other areas, you know?"

"I see what you're saying."

"What else could this be other than contact dermatitis?"

She sighed and licked her lips again. I could tell that the answer was right there but that, for whatever reason, she was afraid to be wrong. The silence was growing uncomfortable. Now she was biting her cheek, obviously deciding whether or not to say something.

I kept telling myself that this was only the third week of internship for them, and that I needed to be mindful of that. I didn't want to apply too much pressure.

Then, this happened.

Ms. Fulsome finally chimed in. "Doctor? What about the other thing we talked about? Remember when you asked me what I thought this was? And then you started teaching me about that?"

"Oh. . . you mean. . . . shingles?"

"Yeah, the shingles. Dr. Manning, she asked me what I thought and I said, 'I wonder if it's shingles?' and she said, 'You know, it could be shingles, it really could. . . but your immune system isn't weak.' Then she taught me a whole bunch about it. But I still was thinking the shingles."

Wow. Ms. Fulsome for the win.

The intern looked at me and discounted their great idea. "She isn't diabetic and she's had several negative HIV tests. My first thought as soon as I saw it was that it could be Herpes Zoster (shingles) but since she isn't immunocompromised I thought against it."

I smiled wide. "Your first thought was right. Both of you."


"Really?" the intern asked incredulously. Ms. Fulsome made a hand gesture that said, "BOOM!" (which I totally and completely loved.)

"Yes, really. This is classic. Ms. Fulsome gives a perfect history, and lots of people with strong immune systems get Zoster or shingles. Have you been under any stress, Ms. Fulsome?"

"Stress? Well, I got three grown people living up in my house that should be living in they're own houses. Them and their kids. They my grandkids, I know, and I love them like crazy. . . .but I'd say having all those mouths at your table and hands pulling on your refrigerator can definitely give you stress." She released a hearty chuckle. "And two of them grands is teenage boys. You know how they eat!"

"I heard that!" I laughed, imagining two Paul Bunyan-sized teens scarfing down food at her table.
Next I pulled off my gloves and tossed them like a ball into the waste basket. "Whelp, it looks like you both were right the first time. This is sho' nuff shingles."

After that, we chatted with Ms. F about the anti-viral medication that she'd need to take and gave her some information about reactivation of the chicken pox virus--aka Herpes Zoster. Once things were wrapped up, we stepped out of the room, pulled the white "discharge" flag and waved good bye to our patient.

The minute we left the room, the intern hung her head. Her morose facial expression completely caught me off guard.

"Oh my gosh! What's wrong?" I queried. She almost looked tearful; her face was a solid mask of defeat and her shoulders rounded and dejected.

"Zoster! Of course. Of course it was zoster. Pain first. Then the rash. In a dermatome distribution." She smacked her hand to her forehead. "I should have known that." Then she whispered with a sigh in a very tiny voice:

"I'm sorry."

dermatomes

Sorry? Oh, hell naw!

Like the touchy-feely mama that I am, I put my arm around her shoulder. "Sorry? Come on, now. That's why we all work together. That's why we are here with you. How do you think I learned? How do you think I still learn?" She shrugged and kept staring down as we walked back to the physician's room like teammates who just lost the big game.

Finally, I halted in front of her and placed both of my hands squarely on her shoulders. "Listen to me, and hear what I'm saying," I firmly spoke while staring into her glassy eyes. "You will never, ever know everything. Never, ever, do you hear me? You did something really great. You asked Ms. Fulsome what SHE thought it was. And you know what? She was right. You respected her enough to ask." Now, she was gazing back at me, riveted and almost scared by the tone of my voice. I went on. "Look. The more patients you see and the more you listen, the more you'll know, period. With experience you'll see things like this and know in a snap exactly what it is." I snapped my fingers for emphasis. "But some days? You won't. You'll be clueless, you will. So you admit it. You look things up. You get another opinion. You ask for help. You ask the patient more questions and get their input. And you learn."

"Yes, ma'am," she whispered.

"I say, 'I don't know for sure' about something every single day. But I just try hard to be curious enough to be bothered by not knowing. That way I'll look it up."

For the first time, she looked a little reassured. Suddenly, an easy smile broke out over her face; her eyes more confident and with a new determination. "You know what, Dr. Manning? I bet I will never miss Zoster now. Not ever."

You know what? I'd bet she's right.

Sigh. I love this job.
***
Happy Tuesday.

Are you dancing like someone's watching?

Kindergarten me--who looks a lot like seventh grade me. Unfortunately.




"I just didn't learn anything new."

Those were the words that leaped from between those lines sent on my Annual Evaluation Summary from the residents I'd worked with last year. A summary that said scores of other things that were beyond flattering. Most of those words affirming what the seventh grade me longed to hear: "I like you. I really like you."

But these words rose up, mighty with teeth gnashing. I like you, yes. But I just didn't learn anything new. So funny that despite being perfectly couched inside words like "amazing role model" and "the best attending I've ever had" how much those words stung. Even though I have not completely separated myself from seventh grade me, I like to think that I have evolved.

But have I?

I remember putting on what I was certain was my coolest mini-dress and leg warmers for an after school dance. I took a deep breath and inched my way into the idle chatter of curvaceous cool girls, hands on their spreading hips, and shirts boasting the outlines of brassieres that, unlike me, they actually needed. One minute into it, I was blending in. Me, who had missed the puberty bus that they'd all boarded the year before and who was about as buxom as a kindergartner, was blending in just fine.

Run DMC pumped out of a tired speaker in our middle school cafeteria as bold tweens did popular dances named for pop culture icons in gender-segregated clusters. This day it was "The Smurf."

"Do you know how to do The Smurf?" one girl asked me, her braces glistening.

"Who me?" I asked, both happy and sad that I'd been noticed.

"Duh! Yeah you," she replied as she nodded her head to the beat while Run DMC repeated over and over "It's like that! And that's the way it is!" The others looked on, arms folded over those developing breasts that I so envied waiting for me to speak.

"Not really. . . Well, kind of," I finally admitted.

"You do?" Cool girl gleefully squealed. "Do it! Do it!"

"Yeah!" chided another, "We don't know how to do it! Do it!"

This did surprise me considering they all seemed to be very much in tune with the music and seemed like the types that would indeed know all of the latest dance moves. Could this, perchance, be my entry to the "cool girl" realm? And so. Against my better judgment . . . . . I did it. I did "The Smurf." With zeal.

Even though I could have sworn that someone was snickering, I decided that I was fitting in, so decided to ignore it. They were all clapping and smiling and sparkling with their braces, so I went for it even more.

"Go Kiiim! Go Kiiiiim!" they chanted.  I was over the moon.

"Hey Kim?" the main brace-faced one finally said, placing her hand on my shoulder and interrupting my groove. "Do you see that speaker over there?" She pointed.

I stopped and looked, smiling and panting. "Yeah, I see it."

"Okay, well how 'bout you go over and stand by it?"

And before I knew it, she nudged me in that direction casting me off like some sort of C list sailboat. Those sounds that seemed like snickers before had become full on unmistakable cackles. I was officially an outsider. I stood next to the speaker all by myself. . .feeling blue, just like a Smurf.

"'Cause it's like that! What? And that's the way it is!"

Sure, I had real friends back then who liked me for me. But damn, I wish I could go back to that day and just keep dancing with all of my might next to that speaker. For me, not them.

See? Back then, I just wanted to be liked. But that was when I was twelve. I'm a grown woman now, so it's different now, right?

I'd like to think so.

"I just didn't learn anything new."

Wow. Nothing new? Not a single new thing? See? I shouldn't have been bothered so much by that. But I was. I so was. Now let me be clear--I'm not the self deprecating type. I think my self image is positive enough to know that I have some strengths as a teacher. I also take formative comments seriously and look for ways to self improve. But today I can't help but take pause at how much those particular words sliced me to the white meat.

So I guess this started me wondering. . . .

Am I still that seventh grader doing The Smurf next to a static-filled speaker? In some ways, aren't we all?


Hmmm. Just wondering. . . . . weigh in, why don't you?

***

Happy Saturday to you (and your inner seventh grader.)

- Posted using BlogPress from my iPad

Gram stains and growing pains.

gram negative rods

gram positive cocci in cluster

 ________________________________________

"All I wanna do

is have some fun

I got a feelin'

I'm not the only one. . ."

~ from Sheryl Crow's "All I Wanna Do"

 ______________________________________

"Are you enjoying yourself?"

"Am I? I'm loving it, Dr. Manning! This is so much better than the classroom. I am loving every minute."

This was the exchange that took place between Joelle, the newly minted clinical medicine student rotating on my team, and me this morning as we trudged up the stairs to go and see a patient. The entire team had just rounded on all of our new admissions from the night before, and Joelle stuck with me for my rounds on the rest of our  service of patients. I loved her answer to that question. It was so genuinely enthusiastic.

"That's wonderful," I responded.  "It's something to love, Joelle. It really is. Enjoy your patients as people. That way you'll continue to love every minute even when you've been doing it for a while."

She looked at me and smiled a big smile.  She was loving it.

In that moment, I thought about my very first clinical rotation.  Like Joelle, I too started on inpatient Internal Medicine fresh off the M2 truck carrying a stethoscope without any scratches anywhere and a short white coat free of so much as even a trace of ring around the collar.  And just like her, I was thrilled at the idea of finally getting to take care of real, live patients on a daily basis in the hospital.

Those first few days were rocky for me. I started out at the VA hospital, and felt swallowed up by it.  I remember standing on the wards listening to rounds and hearing the words flying over my head and whirring past my ears.

DNR, DNI, AMA.

"Excuse me. . . .uhhh. . what does 'DNI' mean?"

"Do not intubate. So like I was saying, this guy has terrible COPD and smokes like a chimney. He was demanding pain meds and got mad when I said no.  He wants to leave AMA." The resident spoke directly toward the attending with virtually zero interest in us medical students hearing, let alone getting what he was talking about.

"Pardon--what is AMA?"

The resident did little to hide his scowl at yet another question. "I'll go over some stuff with you guys after rounds," he replied.  This was his way of telling me to shut my piehole until they finished rounding.  It was one of the last questions I would ask that month.

We never did get around to that teaching session.

The following month was at another hospital. I remember being the student on a team with one intern and one resident. Back then, the lab closed at eight p.m. so any special things you needed overnight fell on the doctors. In our case, it fell on the medical student.

"Take this sputum upstairs and make a gram stain of it, okay?"

I remember raking through my terrified brain for some kind of remote idea of the steps involved in a gram stain. Gram stains tell critical information about the type of bacteria causing certain infections. The whole thing involves multiple steps which yield either germs that hold on to this particular stain (gram positive) or ones that don't (gram negative.)  The kind of antibiotic regimen, the urgency, and all of the management in many serious infections rides heavily on this piece of information which, for reasons that will forever escape me, the resident deemed me the appropriate person to obtain.

Um, yeah.

I recalled the times in our second year Microbiology lab where we'd done the gram staining process. Every single time I'd performed it, I'd done something wrong which always left a little too much stain on the slide.  And so. With me as the technician, everything was "gram positive."

Gulp.

I decided to come clean with my trusting/lazy resident.  "I'm not sure I am so good at the gram stain. Can someone help me?"

"No because we'll be doing a lumbar puncture on that other guy we just admitted."

I'd never seen a lumbar puncture.  I had read about them, yes. But had never seen one in real life. "Can I watch you guys do the LP first?"

Bubble expanding. . . .

"No because we need that sputum result."

Pop!

The resident didn't even look like he needed to think about it. Clearly my experience as a bright-eyed, bushy-tailed fresh off the boat clinical medical student meant zero, zip and nada to him. This was a done deal.  "Oh yeah," he added without even looking at me, "and take this urine, too. It's for that lady with pyelonephritis we just got. Spin it and gram stain it while you're up there." He held up a capped cup filled with a scarily cloudy appearing tea-colored urine specimen.  Great.

So I remember fumbling around in that lab praying that my very bootleg gram stain technique would not lead to some poor unfortunate soul receiving the wrong antibiotic. I panicked, thinking about how much scarier a gram positive rod is versus a gram negative one, depending upon the specimen. For a split second, I thought about throwing out all of the specimens, getting into my car, and driving west until I reached my Momma and Daddy's doorstep at home. I decided against that, considering there were sick patients involved.

I stained the sputum first. Gram positive.

Oh Lawd. 

Next came the urine. I spun it in the centrifuge, nearly catapulting across the room at first when I didn't close the top on the machine. Whoops.  I stood there praying that I would get it right while making the slide. I wasn't grown up praying--I was praying in that eight-year-old way you pray when you release a bowling ball into the lane and it's headed for the gutter.

Please Lord don't be a gutter ball. Please Lord don't be a gutter ball.

I felt like my bootleg gram stain was headed in a similar direction. Please, please, please. . . .gasp. . . is that. . .gram negative?  I am pretty sure I did the happy dance once I confirmed under the microscope that it was indeed gram negative rods---the typical and expected bacteria of a young woman with a urinary tract infection.

Hallelujah.

I made it back just in time to get handed a specimen bag full of spinal fluid. "Go spin this and stain it."

Nice.

This is what they call getting "scutted." I pretty much got scutted for the majority of that month. The good part of it is that me and a few of my classmates got pretty proficient at random laboratory procedures. The bad part is that I missed out on some high yield things, mostly because I was being sent off on scavenger hunts during all of the action. Even still, I can appreciate the experiential learning that I had while doing all of it. I guess.

But.

The worse parts of both of these months were my interactions with my attending physicians. I was pretty much invisible. And seeing as I have never been invisible anywhere, this was a hard pill to swallow. I will never forget the day that, after like ten whole days of being on the service and rounding with the team, my attending said, "Hello, are you going to be one of the student doctors here with us? What's you're name?"

"Kimberly Draper," I answered quietly, "and actually, I've been here for just about two weeks."

You know, the one that's been spinning down pee and staining up your patients' hocked up loogies all night on every call?! You know, the one that manually evacuated the horrifically constipated bowels of that ninety-nine year old woman two days ago-- upon your request?  You know, the one that introduced herself to you four times already this month?!? 

"Oh okay, then. Nice to meet you, Kimberly."  

Jerk.

From that moment forward, I made a vow. When I grow up, I will never, ever ignore the medical students. Ever. I will never not know who I am working with. I will never allow any hardworking human being on my team--be they a medical student, pharmacy student, pharmacy resident, Physican Assistant student, or visiting student--feel as invisible as I felt over those two months.  Ever.

Fortunately, I had some great role models on my other rotations who paid (sometimes too much) attention to us medical students. But I still will never forget that first rotation and how it made me feel about Internal Medicine.  I pretty much decided that I hated Internal Medicine based upon this experience, only to learn from one of my surgical attendings that "liking the patients on the wards but not the OR isn't really consistent with being a surgeon. That's called Internal Medicine, sweetie."

Ah hah.

I suppose being looked through or not important enough to be memorable after four separate introductions had left me feeling as washed out as those gram negative rods. As much as I'd wanted to hold onto some positive aspect of the experience, all I was left with was a faded version of it any time I looked under the microscope. Which sucked.

Yeah.

So for this reason, poor Joelle and countless other medical students on ward teams past and present  have been schlepped all over the hospital and up more flights of stairs with me than can be quantified. . . . .here, there, everywhere. Seeing patients. Listening to heart murmurs. Discussing hard diagnoses. Holding peoples' hands. And a few times, even looking at gram stains in the lab. But without fail, whenever we do that, we talk. About non medical things and fears and feelings. I try my hardest to find out the things I wish my attending had asked me back then. Like. . . .

"Where are you from?"
"What's your favorite food?"
"What are your hobbies?"
"Do you speak any other languages?"
"Where have you traveled?"
"What kind of talents to you have?"
"What are your mom and dad like?"
"Wow! You did a half-iron man?"


And stuff like that.


But I especially ask this one. . . .

"Are you enjoying yourself?"

Because now that I think of it. . . on many days when I'm teaching + learning + caring for patients at Grady. . . .all I wanna do is have some fun. And you know what? I've got a feeling I'm not the only one.

Olivier, a former student at commencement (with his parents) -- More than a gram-stainer, indeed.