All day, e'ry day.

I was talking to a man in clinic the other day. A big, strong man in his sixties with a deep voice and a throaty laugh. His muscle tone rivaled that of a teenager and at one point in the visit, he even pulled up his sleeve to flex a bicep for proof.

"Man, I bet I can still do more push ups than this young guy can do!" He gestured over to his resident doctor with a challenging twinkle in his eye. His doctor quickly waved his hands in full surrender, laughing out loud and assuring our patient that he was correct in that assumption.

"I even got the six pack still." Our patient pulled up the side of his t-shirt with one hand and pointed to his abdominal muscles with the other.

"Wow, sir. That's impressive!" His resident doctor couldn't help but release an incredulous chuckle when he said that. And me, I just smiled at the entire exchange because this patient and his doctor were enjoying one another and I think that's therapeutic.

"Do you exercise a lot?" I asked.

"I'm jest a doer," he said. "I get outside and mow the lawn, chop some wood, do some projects around my yard and other folks' yards. Do some push ups with my grandsons and sometimes run outside and play some football with 'em when these knees ain't bothering me."

"That's awesome." And I said that because it was pretty awesome to hear of the kinds of easy, everyday activities that had helped a man who was nearly old enough to get a social security check maintain a body like this. Kind of like he'd figured something out that we hadn't.

"How many grandkids do you have?" I always like knowing these things. We'd already reviewed the plan with him and were on to the pleasantries--which is often my favorite part of the visit.

"Nine of 'em. Five grandsons and four granddaughters. And love 'em all to pieces."

"That's so cool that you play football with your grandsons."

"Yep. All them grands is athletic like they granddaddy. I play basketball with 'em and even play some volleyball with my oldest granddaughter. She ain't thank ol' granddaddy could spike that ball but I had somethin' for her!" He laughed out loud and mimicked a spiking motion when he said it. We all joined in and laughed with him.

"You are the first granddaddy I've ever met who spikes a volleyball and has six pack abs. That's for certain!"

"You shoulda seen me when I was a young dude. I had a twelve pack back then!"

And this was how this part of the visit went. Fluffy, confluent laughter and animated gestures. Us asking and him telling and all of it bringing us closer to better understanding exactly who our patient really is.

His voice had this musical quality to it. Mostly southern but almost like a radio personality. And since his resident doctor was still entering in orders and preparing the after visit summary, I decided to ask a few more small-talky questions since I was enjoying hearing about his life so much.

"I like your voice, sir. Where are you from?"

"Right here, baby. Rights HERE!" He pointed at the floor. "I'm a Grady baby."

I playfully bowed before him. "Oh. . .man, that makes you royalty."

"Is that right?"

"You know it!"

"Did you play any sports in school or after?" I was curious about this, too. Any sixty-something year old man who was diving for a volleyball and tackling his grandsons in the front yard had to have a good sports story behind all of that.

"Sho' did. All day e'ry day! Played it all and was good at everything. You ever met somebody like that? Just pick up any sport and good at it?"

I smiled when he said that because we've often said this about our son Zachary. "Yes, sir. I know just what you mean."

"Yeah, well that was me. I could play anything you put in front a' me. Some of my grands is the same way. Bet one of 'em gon' make it to the pros long as they figure that school part out."

I nodded when he said that because he was right about the school part. I wondered if there was more to that, but not for long because he went on.

"Tha's what did me in. Well, that and the times, you know? I got all the way up to the eleventh and couldn't do nothing past third grade level. That held me back real bad. I was gon' play baseball or football at one of the colleges but couldn't because of that."

I furrowed my brow and leaned my chin into my hand. "Because you had trouble with your school work?"

"It was more than trouble. I can't read or write. Well--I take that back--I can write my name and some numbers down. That's about it. And them schools back then just pushed me on along. And when them college people came to talk to me they give you papers to look at and fill out. I was too shamed to say I can't read none of this. And it ain't like I could take it home and get mother or daddy to do it 'cause they ain't read none neither."

The resident doctor froze on the keyboard midstroke and looked at his patient. "Do you still not read or write?" he asked.

"Nope. No more than basic stuff. Like real, real basic stuff."

I have no idea what prompted me to ask this next question but I guess he'd just been so open that I felt comfortable digging a bit deeper. "What is it like. . . .I mean. . . you know. . . to . . "

He didn't make me finish that awkward query. "To not know how to read or write? Man! It's terrible! Terrible, do you hear me?" He shook his head hard and for the first time his face grew serious. His eyes became distant and quiet. So did his voice. "My biggest fear. . . . my biggest fear is the day one of my grandbabies look at me and ask me, 'Granddaddy, what do that spell?'"  He wiped his hand over his face and sighed hard.

I didn't know what to say. But really, what was there to say? This man had gone up to the eleventh grade without being literate. He'd been failed by a system and the whole thing sucked. Every bit of it.

"But you know what? I got hustle in me so I always made it happen. And usually I ain't had no problem admitting to folks that I don't read and write so I always managed to do stuff that don't require all that. I made my living and been jest fine."

"That's good," I said.

"It's jest that them grands came along and something about telling them that they granddaddy don't read or write? My voice jest go silent. Like I want them to feel proud a' they granddaddy, you know? And they are. Proud a' how they granddaddy do for them and do stuff with them like other granddaddies can't. I hate the thought of them being disappointed in me 'bout something basic as that."

"My bet is that there's nothing you could do to make them not be proud of you."

"I reckon you're right, Miss Manning. But that's still hard."

"I know." I wrinkled my nose and shook my head quickly when I said that. "I mean--I don't know. But I think it sounds really hard."

He sighed and gave his head one nod. "Yeah."

Instead of giving him a pre-printed after visit summary, we spent more time explaining the plan and the follow up appointments. We went to the social worker and looked on line for literacy programs and made a plan to explore programs for teaching adults to read. And our patient seemed genuinely excited about all of it. Even more excited than he was to show us his six pack abs.

Here is what I know for sure: Every single patient has a story all their own. Filled with experiences and triumphs and tragedies. Packed with thoughts and fears and beliefs and goals. And all of it is there just waiting for us to explore it, ask about it, hear about it. The journey becomes richer. The caring relationship blossoms into something symbiotic.

This moment with this granddaddy was just one tiny piece of my day in clinic the other day. It is a slice of humanity--the kind you have to slow down to savor.

And this? This is Grady. All day, e'ry day.

***
Happy Wednesday.

Diploma, see?

Encounter on a Wednesday


Did the things you asked of him
but didn't do them quite right
even though
you'd written them all down
word for word

Do this, you wrote
Avoid that, you added
Go here, you underlined
And whatever you do
go there, sir

You'd written it all down
word for word
and put it in his hand
so he wouldn't forget
couldn't forget

It's important, you implored

Okay, he replied

Okay

So he kept the appointments with you
but missed the others
All of the others
that you'd worked so hard
to get him scheduled into

Did you get the MRI?
No.

Did you see the neurologist?
No.

Did you get the ultrasound of your heart?
You know. The echo?
 No.

But see, he kept the appointments with you
All of them
And he smiled and nodded when you talked to him
so why wouldn't he
get the MRI
or go see the neurologist
or get his heart ultrasounded.
Or, you know, echoed

"Do you know if he can read?" This was my question.

"He finished high school," you replied.

"Yes," I asked, "but, again, is he comfortable with reading?"

And you became silent for a moment
then admitted quietly that you weren't completely sure

Even though you were sure
that he'd completed high school

"You tell him when his follow up appointment with you is scheduled.
But the others come in the mail."

You nodded in response

But
He did finish high school

He did.

So we went in and talked to him
Explored why it was hard for him to do things like
get an MRI
or go see a neurologist
or get his heart imaged in two dimensions

"I try my best."

And so we asked, this time specifically.
Not could he read in the black and white sense
But how comfortable he was with it
in the gray sense

That's when he gave us a clearer understanding
of his gray areas

"I can't read none."

None.

Yes, a high school graduate
with a job
and kids
and medical problems, too

With a high school diploma
and an inability to read or write

Yeah

And so
we wrapped up the visit
with this new piece of information in mind

Glad for what we'd gleaned
to help us understand him more
and sad that this wasn't the first time
that he'd slipped between the cracks

***

Yet do I marvel.

Someone asked me the other day--or rather they made more of a statement to me:

"I'm so amazed that you've been able to write with all that's going on."

I wasn't really sure what to make of that, but I'm pretty certain that it wasn't meant to be insulting so I just shrugged. Because I'm kind of amazed, too.

I won't really go into that much more, but instead I'll just say that I'm glad to have a voice. Man, I am.

Speaking of which.

I received a message yesterday from one of the former students in my very first small group. It wasn't a message of condolence or any such thing. I had already heard from this student very shortly after Deanna left us. This time, the message was for another reason. He reached out to share a pivotal moment he'd had in patient care. And that's all.

The note was straightforward. He was taking care of a man with some cognitive issues and very limited literacy. An elder with not even a full elementary education and the kind of difficulty understanding things that was even harder back then because there weren't any names for such things or early interventions.

Yeah.

So anyways. Tony, from Small Group Alpha, is now a second year ENT resident. You can say "ear, nose, and throat" or, if you want to be all fancy with it, you can flex your linguistic muscles and say the proper name for it: "otolaryngology." Regardless of what you call it, that's what he's doing and I'm always elated to hear how it's going and how he's growing. And I'm glad that Tony still has a way and a desire to tell me about moments such as this.

This elder unfortunately had a recurrent throat cancer. Laryngeal cancer, to be exact. And Tony, being the head and neck surgeon (they go by that, too) was charged with coming in there to see this man and talk to him all about this procedure he was going to have. A procedure that would take away his ability to speak. For good.

And isn't it perfect that I'd receive this message at a time when people are thinking of things to be thankful for? We think of many things, but usually not our voice. At least I don't.

Well, Tony spent a lot of time talking to this gentleman and did so with care. No, I wasn't there, but I was there from the first day Tony started medical school. I listened to him and talked to him over the years so I know that it was important to him that this man understand what this surgery would entail. No matter how long it took, without question, I can say that Tony wanted to do all he could to afford this patient the chance to make the most informed decision possible.

And so. He talked. He explained. Carefully. And fully caring, too.

The gentleman had a tracheostomy tube in his throat at the time which limited his ability to speak during that conversation. But not yet permanently because there are speaking valves and such than can be used to help people talk. That is, if they have a larynx.

So after this young doctor spent all of that time speaking to him, he bit the bullet and did the thing that we are all taught to do but often come up with excuses to avoid. Ask the patient to tell back--or teach back--exactly what the gist of the plan is based upon their understanding.

This can be loaded. Mostly because if the person gets it all wrong, you're back at square one. Which, in my opinion, you're at whether you confirm it or not when the patient doesn't understand. A lot of times we feel the pressure of a ticking clock looming over us. The cop out question gets asked: "Any questions?" Which, most of the time, is often met with a "not right now."

That, or just one or two tiny ones that often gives the doctor the "dat'll do" wrap-up they were looking for. Especially if they are generic enough questions to convince us that we've explained things well.

But Tony did something even more extraordinary. He asked this question -- "What is your understanding of this surgery that I just talked to you about?" -- to a patient with a less than sixth grade education and some learning disabilities who also could not respond verbally. Having him write would be very tedious -- and time consuming -- but there wasn't another option.

Still, though, he asked. He respected that man enough to ask. Even more, he respected him enough to talk to him with the dignity he deserved and then positioned himself to have to wipe down the chalkboard and start all over again. He sure did.

And so. As his doctor patiently waited, the man took a piece of paper and scrawled these words in response to that question:

And I will tell you exactly what Tony said to me about this:

"Not sure exactly why yet, but I know this is one of the most important images that I'll see during my training."


I think he's right.

That entire note moved me in the deepest parts of my soul. I needed to hear that yesterday. Some other person's reality. If only for a moment, you know? Does that even make sense? I don't know.

Though I didn't cry, I did immediately feel like I wanted to when I saw this. And I'm not sure if it had to do with the fact that this man was losing his voice for good or the fact that this young doctor caring for him took the time to give him one.

Perhaps it's a bit of both.

Our voice is a gift. No matter what is going on, it is. And though I thought I knew that, this story underscored that for me even more.

I have this label I often use that you've seen and perhaps wondered about -- "yet do I marvel." (I know Nancy doesn't because she's all about the poetry, but others may wonder.) It comes from a poem from the Harlem Renaissance by a poet named Countee Cullen called "Yet Do I Marvel." There's lots of interpretations of the poem, so I won't go into all of that. What I will say is that I think the poem is hopeful and celebratory and not a lamentation. Against all odds, particularly the ones a man of color such as this author faced in the 1920's, he still had a voice. A voice!

So sometimes I see things and I just think to myself, "Wow." Because I'm just glad to be here. In spite of all that is going on in the world, I'm glad that I'm here to bear witness. I'm glad for hearts worn directly on sleeves. And especially in the time that I am walking through right now, I am glad for a voice.

A voice.

So to the dear person who couldn't believe that I could still write and talk through such unspeakable grief, I will share with you the poem my mother read to me as an elementary school kid -- likely close to the very age that patient was when he finished his education for good. Even though life doesn't make sense sometimes, there is always something in which to marvel.

At least that's what I think.

***

Yet Do I Marvel

I doubt not God is good, well-meaning, kind,

And did He stoop to quibble could tell why

The little buried mole continues blind,   

Why flesh that mirrors Him must some day die,

Make plain the reason tortured Tantalus

Is baited by the fickle fruit, declare   

If merely brute caprice dooms Sisyphus

To struggle up a never-ending stair.   

Inscrutable His ways are, and immune   

To catechism by a mind too strewn   

With petty cares to slightly understand   

What awful brain compels His awful hand.   

Yet do I marvel at this curious thing:   

To make a poet black, and bid him sing!

~ Countee Cullen

***

Happy Sunday.

Mass confusion.

It a little bit sound like the Charlie Brown-cartoon-grown-up voice. All wobbled up and hard for somebody to understand. I keep looking at her and she looking at me. I'm smiling so she won't think I'm confused.

But I am.

Okay. I ain't stupid. I know I ain't. But this? It's so much so fast. Something 'bout how at first there was one medicine but that one did something and now she want to try another one. Big words for no reason keep throwing me off. She seem like she in a hurry, too. At some point, I just said bump it. I'll just see if the man at the WalMart pharmacy can help me.

Keep smiling. Smiling while she looking over all my pill bottles.

"This one is renal protective. Since you have diabetes that's a medicine you need to be on but your potassium has been creeping up. We'd thought about holding that one but there's also the added benefit of ventricular remodeling with your heart failure. In other words, how the heart is shaped and how it responds to all that's going on with you."

She set that bottle down after she said that part. It felt like a door slamming on me. Right in my face.

"Uh huh."

Still smiling.

"You with me, Mr. Allen?"

I just nod 'cause I don't want her to start over.

Now. What the hell do RENOPROTECTIVE mean anyway? I don't know. But she been talking  so much and for so long that I don't even want to ask. She seem like she care so much, too. But she talk so fast and with all these fancy ways to say stuff. RENOPROTECTIVE? What? And the remodel part don't mean nothing to me. I hope it mean something to the man at the WalMart pharmacy.

Smiling. Head nodding.

"There's a lot of compelling data to support us keeping an eye on the the K since the benefits far outweigh the risks of you being on an ACE."

K? What the hell is that?

"Oh. I almost forgot. K is just our abbreviated name for potassium. It's a salt in your body."

"Oh, okay."

"So, we'll keep the ACE on board and the thiazide, too. I also think it's a good idea to switch this atenolol to Coreg. I have no idea what you were doing on that atenolol when you have known systolic dysfunction."

Because y'all prescribed it when I was in the hospital, that's why. "Okay, then."

"Carvedilol is the superior beta blocker for patients with heart failure. There's plenty of good data to support that. It's more potent, too, so I think we'll get the most bang for our buck there."

I thought you just said a different name. Now I'm confused.

"Question, sir?"

"Uhhh. . . what is Coreg?"

"Carvedilol. That's just the trade name for it."

"Oh, okay."

Trade name? Whatever that is. So why the hell are you going between two names for it anyway? I don't even know what it is. But something about it being superior or whatever the hell she keep saying sounds okay, I guess. I guess.

Smiling. Nodding my head some more.

Here's the thing. I don't get ninety percent of what she say to me. But it seem like she care and like she smart. So even if it sound crazy, I just go with what she say.

Now she studying all my pill bottles like somebody gon' test her on 'em later. I kind of have to pee but hopefully we almost finished.

"Hey! What's this?"

Now she's looking at another bottle and her face is all twisted. Shit, I don't know. I just brought in my bag with all my bottles like you said to do. They changed some medicines when I was in the hospital last month and I thought all this was in that computer. Why then, she got to act all surprised like nobody is talking to nobody?

"How long have you been on this clonidine?"

Cloni-who?

I take the bottle and look at it. "That's from when I was in the hospital. I started it after I left."

"Uggh. I hate clonidine. What the heck were these guys thinking? Clonidine? Atenolol? Are you kidding me?"

I don't think them questions was for me. It was for the air, the situation and for herself. Words that woulda probably been spoken even if I wasn't there. Here's what I just decided. It make me kinda uneasy when one doctor make it seem like another doctor ain't doing right by you. Seem to me like everybody need to get on one page.

But the cloni-whatever wasn't my favorite. I stopped it like a week ago since it didn't agree with me. Why not tell her?

"That pill make me feel a little bit drowsy so I don't always take it."

Damn. What did I say that for? Now she shaking her head and mumbling some more stuff about the other doctor who gave me that medicine. But I was just being honest.

"Clonidine isn't always best for everyone. Yes, it can make you drowsy and it also causes rebound hypertension."

Whatever that is.

"When was the last time you took it, sir?"

"Ummm, I think yesterday." And by yesterday, I mean last week.

"Yesterday? Ugggh. Okay."

Now she typing all fast into that computer. I kind of like that they put the notes in the computer. But  look to me like they'd have some better idea of what's happening if they looked at what each other was doing.

"Maybe I took the clonidine last week. Not yesterday."

"Okay. Well we're stopping that anyway. The Coreg should do the trick, I think." She paused for a moment like she was about to say something else. "You still smoking?"

Shit.

"Uuuuhhhh. . . "

"I can smell cigarettes on you, sir. It's okay, you can tell me."

I smell onions on your breath from your lunch break but I didn't just call your ass out on it. Damn.

"I cut back a lot, though."

"What's that mean?"

"A pack last me three days now. That's a lot less."

Now that part was true. Last time she was pushing me to make a 'quit date' and to get her off my back I just went on and said I'd quit on my birthday. That day came and went.

"Hmm, okay. I know we'd set that quit date before. How are you feeling about quitting?"

"I want to quit."

That's true, too. Eventually I want to quit. But as far as being real, real ready to quit right this second, no. I drive trucks. I ain't really in no position to not smoke. What truck driver don't smoke? Well. There's Jimmy who quit. I think Big Marsha quit, too and she was a chain smoker. They went cold turkeys and I ain't so sure about that.

"Okay. We can set another quit date and this time use some nicotine replacement. How's that sound?"

It sound good for somebody ready to quit. I said I want to not I'm ready to. And I heard them nicotine patches make your skin break out and make you feel all jittery. She looking all up in my face so I better not say nothing, though.

"I guess that's okay."

"Okay, great." She starts squinting at this calendar on the wall. "What do you think about Thanksgiving?"

"What do I think about it?"

"Yes. As a quit date?"

"For the cigarettes?"

"Yes, Mr. Allen. That would be a great way to celebrate your Thanksgiving. What do you think about Thanksgiving?"

Here's what I think about Thanksgiving. I think I'm gon' have me some pie and loosen up my belt buckle after a big plate of food. Maybe two plates. I think I'm gon' play some bid whist, spades and dominoes with my sister and my brothers and my sons and we gon' talk shit and drink Jim Beam. And we also gon' smoke. That's what I think about Thanksgiving.

"That might be a little soon."

"Okay. How about Christmas?"

How about changing the subject? How 'bout you recognizing that we do the same thing on Christmas as we do on Thanksgiving?

"What do you say, Mr. Allen?"

This time she winked at me.

"Um, yeah, okay."

"Great, sir. That's great!"

More typing.

"We have flu shots in. So we'll give you one of those today, okay?"

Today? Damn. I'm not so keen on those. Last time my arm hurt for two whole weeks. But if I say no she gon' say what she said last year about me having sugar and how if I get the flu I could die. I don't know anybody who got the flu and died. Not a one person.

"Can I wait on that?"

"I wouldn't recommend it. You know you have diabetes and heart failure and if you were to get influenza it could be life threatening."

Told you. Now it's heart failure, too that will kill me with the flu? I just don't have it in me to fight. Plus my bladder feels very, very full and I want to just pee and then leave. See? That's why I don't like taking my water pill on the day I see the doctor.

"Okay."

"Okay for the flu shot?"

"I guess."

She holds a thumbs up. I smile. Again.

The last part involve something about this colon test I have coming up in a month. How it's very, very important for me to get this, especially since I'm Afro-American. I don't even remember saying I wanted that test. Or us talking about it. I do remember when my brother Charles Edward got that test. He said that stuff they give him the day before had his bowels running off so bad he thought he had the choler-y.

"It's only every ten years. Unless they find a mass or something."

A mass? What the?

"You know, like a polyp or something."

Charles Edward didn't say nothing about that.

"What happen if you don't get that test?"

She already revved up. "Well, if you had a colonic mass and it went undetected you could have colon cancer spread all through your body. The most aggressive forms affect African-Americans."

Here we go with that again. When did we switch from being black? Are we still black? I don't even know. I know we ain't colored. But NAACP still got the word 'colored' in it. I wonder why? Hmm. Hell if I know. I'm just ready to go.

"So that's on the twenty-second, okay, sir?"

"That's fine, ma'am. Are we just about finished up? I want to get to this pharmacy, you know." And to this bathroom. "Plus my son waiting on me, you know, and he got to get on to work."

"Absolutely."

Typed some more. Said a few more things, this time even faster than all the other stuff. Then when she was done with all of that she reached out and touched my hand.

"I love taking care of you, Mr. Allen. I hope you know that."

I smiled because that was kind. "I like you, too, doctor."

"Let me know if there's ever anything I can do to take better care of you, okay?"

She still got her hand on my hand and she looking all in my face like she really want to hear what I got to say. And man, I do got so much stuff to say.

Like:

You can slow down. You can use some smaller words. You can maybe draw it on a piece of paper for me. You can know that ACE and K and COREG and CARVEDILOL and COMPELLING DATA are words that sound like another language to me but how you say them in my direction seem like you think I speak it. I don't. So you could know that.

And:

You can not say nothing bad about the other doctor that saw me in the hospital. You can look inside the computer to see what they did. You can let me see how I feel about cigarettes. And flu shots. And not scare and confuse the shit out of me by saying something about a mass on my colon. You can just overall explain stuff to me different. Slower. Less fancy-like. You can know that even though I can read and write it don't mean I get all that you say. You can remember that when you talk to me. All that. That would make it better for me.

It would. It really, really would.

But that's a lot. And saying all that would make my son wait longer in that waiting area and my bladder almost explode. Plus it might hurt her feelings 'cause Lord knows it seem like she thinking hard and long about me. So I keep it simple.

"Okay, doc. I will."

"Alright, Mr. Allen. See you in three months?"

"Yes, ma'am. Three months."

***
Happy Saturday.

I'm here.

Got my house

It still keeps the cold out

Got my chair

When my body can't hold out

Got my hands doin' things like they s'posed to

Showing my heart to the folks that I'm close to

I got my eyes though they don't see as far now

They see more 'bout how things really are now

And I'm thankful for each day that I'm given

Both the easy and the hard ones I'm liven'

But most of all

Yes, I'm thankful for lovin' 

who I really am. . .

I'm beautiful

Yes, I'm beautiful

And I'm here.

~ "I'm Here" from The Color Purple 

_________________________________________________

I saw a lady recently whose chart wasn't making sense. Kept all of her appointments but wasn't following through on the plans her doctors gave her.

"That's weird, don't you think?" I said to the resident caring for her. "Doesn't make sense to come to the doctor but not do what the doctor tells you to do."

"It is kind of weird." My resident squinted one eye and thought for a bit then shrugged. "I'm not sure if she has some. . .I don't know. . .cognitive issues. I give her clear instructions and, I kid you not, when I see her again it's like it never happened. It's crazy."

"Who does she live with?"

"Her daughter. . . I think. . . hmmm." She tapped her finger on her lip. "I don't really remember. I know her daughter is very involved. She usually comes with her to the visits but isn't here today."

I nodded my head. Okay. That gesture meant that I'd heard enough and wanted to talk to the patient for myself.

We knocked on the door and entered the room. I had just put hand sanitizer on my hands and rubbed them vigorously together in preparation to shake her hand.

"Good afternoon, Ms. Jane. I'm Dr. Manning and I'm the senior doctor working with your doctor today."

"Hi Miss Manning," she replied with a big smile. I returned the gesture because for whatever reason I find the "miss" instead of "doctor" thing more endearing than offensive.

I sat on a chair and repeated several of the points her doctor had already spoken to her about. We chatted about her diabetes and how concerned we were about her taking the insulin the wrong way. Next we talked about the anti-platelet medicine called Plavix that she was still supposed to be taking but had stopped. Lastly we sorted out the blood pressure medication and reaffirmed that it was good that she was taking the cholesterol pill at night like it was prescribed.

She was very engaged and followed every word. So earnest and focused. So respectful and invested. So why were the plans unraveling every time? This didn't make sense.

"I hear your daughter is normally here with you? I'm sorry I didn't get to meet her."

"She got a different job that don't let her off so easy," she said. "She normally like to come but haven't been to my last few doctor 'perntments because-a her job."

"Do you live with her?" I appreciated that natural segue.

"No ma'am. But she do see about me."

I nodded my head. What came next should be predictable to you at this point if you know me or you've been reading here for a while. Yep. I started exploring the story. Her story.

"Ms. Jane? Where'd you grow up?"

"I grew up in Alabama. In the country."

"Is that where school was for you?"

My resident watched, knowing this line of questioning well. Her facial expression said it all--Here we go with Dr. Manning's line of literacy questions. 

"Yes, ma'am."

"What grade did you make it to?" I continued.

"I made to the tenth. But tha's when school only went to the tenth so I finished."

My resident looked at me and somewhere in her eyes I saw a tiny flicker of triumph.Or perhaps relief that her attending hadn't just uncovered literacy as the reason for nonadherance to the medical plan.

"What kind of work did you used to do?" I recalled that the resident had told me she was retired.

"Housekeeping and such. But I been retired a long time."

I nodded again. Then I just sat there in silence thinking of what to say next. Polite Ms. Jane waited patiently for me to find the next question.

"Ms. Jane? Do you ever. . . like. . .does it ever get kind of confusing to you to keep track of all your medicines and directions from us?"

That question caught her off guard. Her eyebrows raised. "Beg pardon?"

"You make the appointments but some parts . . . I mean. . .it seems like maybe it was hard to keep track of."

Ms. Jane just watched me for a moment, studying my face to see where I was coming from. She carefully answered me.

"Sometime. Sometime if my daughter not there it's kind of hard."

"What does your daughter help with?"

"She help with telling me what I'm s'posed to be doing and what all y'all want me to do. She good with all that stuff."

"Ms. Jane? What about when we mail things to you or give you papers to read? Do you feel comfortable with looking over that stuff if your daughter is at work?"

Again she hesitated. Then finally she spoke. "Sometimes. . . .no."

"Does your daughter realize that? I mean. . .that like. . .if she isn't there that you might have some trouble with the papers?" I chose my words carefully.

"Do she realize? Realize that. . . what? You mean. . . . " She froze and then readjusted herself in her seat. That was enough to stop her from finishing her sentence.

Letting go of our eye contact I looked down at a piece of paper in front of me and spoke while doodling with a nearby ink pen. "Sometimes, Ms. Jane. . .even when you went all the way through school, it's some stuff you didn't get. And that's okay, you know? Because nobody knows everything perfect." I looked up again and reestablished our gaze.

This was cryptic, I knew it was. But I was trying my hardest not to come right out and ask. But Ms. Jane had my number and understood where I was going. Her eyes began to fill with tears.

"Ms. Jane?" I said her name again to hold her attention. "There's some stuff I didn't learn well in medical school. I think to myself. . .  sometimes . . . .if people knew the things I wasn't so sure about they might laugh at me, you know? Then I just tell myself that it's okay to not be sure about everything. It's always good to keep learning."

The tears began to spill onto her cheeks and she wiped them quickly. She placed her hands into her lap and began to wring them nervously. "One time," she started and then stopped. She took a deep breath and went on. "One time, my daughter was at her new job and I got a paper from Grady. I know the Grady red sign so knew it was from y'all. I took it next door to my neighbor and asked her to help me. I told her I couldn't see it without my readers and could she read it for me." Then she began to weep. Hard.

I handed her the tissue passed to me by the resident and waited for her to finish.

"My neighbor--she so nice--she turned around and came back with a pair of readers. 'I got a spare,' she said. And she gave me her readers and closed the door. And I was jest standing there with them readers and them papers not knowing what to do." Her face twisted up in this complex mixture of shame and relief. It was like we'd rubbed a genie out of a bottle.

I  tread delicately--careful not to make assumptions. "So. . . .the readers weren't enough?"

Ms. Jane shook her head and squeezed her eyes tight, like somebody bracing for impact. "I don't read good, Miss Manning." Then she crumbled into full-on weeping but pressed on. "I be wishing I could read good but I didn't never learn. I wanted to go back to learn but I never had no time. It make you feel so bad, too, not reading. Like you always got to count on somebody."

I felt a lump building in my throat. "Does your . . . daughter know?"

Her forlorn expression told me that answer. More tears. More shame.

"The newspaper. It come to my house every single day. Every morning I take it out the plastic, open it up and look at the words and the pictures. Hoping it's jest gon' unlock in me one day. And nobody think I can't read good since I get the paper, you know? But to me, it's jest words and pictures and nothing else."

Now my eyes were welling up, too. I could see the unfolded sheets sprawled across her kitchen table. I could feel the defeat she felt when her well-meaning neighbor handed her a pair of reading glasses.

Damn.

"I'm so glad you told us. I'm so, so glad." I reached out and squeezed her hand and I swear to you it felt like someone deflating a balloon under pressure.

"We can make it a lot easier for you, okay? Thank you for telling us that," her resident doctor said. And that resident smiled at her warm and genuine which Ms. Jane seemed to appreciate.

I did, too.

And so. We spoke to our Grady pharmacists who swooped right in to help. They smiled and listened an normalized something that she'd been ashamed of for more than sixty years. Then they gave her a card that explained all of her pills with pictures instead of words making it easy for her to follow whether she  had readers or not.

image credit

When the visit ended, we shifted off of the low-literacy issue out of fear that making such a big deal about it might make her feel self conscious. So I excused myself while they wrapped things up and shook her hand like it was really no big deal.

Even though it was.

Right before I left the room, I caught a glimpse of her pocketbook sitting beside her on the desk. Under it was a stack of papers from Grady tucked neatly into a manila folder. And peeking out of the mouth of that purse? Today's issue of the Atlanta Journal Constitution. Refolded because it had clearly been opened earlier that day.

Once I closed the door it dawned on me. Today, something did unlock. Right there in that room when one brave soul had the courage to tell her doctors that she could not read.

When I got into my car to head home and thought about that exchange, it hit me. Really hit me. I cried all the way home. No, Ms. Jane. You don't read good, but you're here.

You're here!

And now I'm crying again because I'm just so proud to be a Grady doctor. So appreciative to be where I am. So blessed to be here, too.

I'm here. We're here.

Yeah.

***
Happy Tuesday.

Now playing on my mental iPod. . . . Fantasia brings it home and puts me on my feet just like she did when I saw her singing this on Broadway. This is a song for every person who is still here. . . .damn, it is. (It sounds best when you periodically yell out, "Girrrrrl! You betta SANG that SONG!")

You make a grown man cry.

"You make a grown man cry. . . ."

~ Mick Jagger in "Start me up."

That first day you went off on me and everyone else.

"I'm in pain!" you yelled in no particular direction.

"I will work on your pain," I said back to you, my voice decidedly softer than yours.

"Yeah, right." That's what you retorted. Phtooo. Take that.

The next day I ask you, "How do you feel?"

Again you light me up, this time threatening to kick me out altogether.  "Worse! Worse! I'm in pain! Y'all got my medicines all confused and I'm still in pain!"

And see, you have a reason to be in pain. This is not some "soft call" where you have a little ache in your back or a visit from Arthur-itis.  No, this pain is legit. And this analgesia you're calling out for is warranted.

I take your venom and withstand your anger because I know it's really at the pain and not me. And, seeing as you're a born-at-Grady elder who happens to be old enough to remember the segregated "Gradys", then that gives you license to go off whenever you feel ready.

"Okay, let me compare your home medications to what we are doing here," I reply.  "Were your home medications helping at all?"

"They were working better than what y'all doing! This don't even seem like it's as much as what I was getting at home and I thought I was s'posed to be getting my pain medicines worked out. This is some bullshit."

"Sir. . .I'm sorry. Please. . .let me look at--"

"Get out, please. Just get out. I need some rest. I'm tired and my body is hurting. Just go."

"Okay. I'm going to put you back on your home medicines and then move up from there. Okay, I'll leave now."

"And turn my television that YOU shut off back on 'fore you go."

"Yes, sir."

"And get that bright ass light, too."

I click it off on the way out and leave with my tail between my legs.

As a team we carefully reconcile your home medicines with your hospital medicines. Looks like we were a few milligrams under what you'd been getting, and we bring it all to speed by changing the orders.

The third day I come in to see you and your back is to me.

"Hey there, sir. I'm making my rounds and I'm here to see about you."

No answer.

"How are you feeling?"

"Terrible."

"Terrible?"

"Terrible."

"The medicines aren't taking the edge off?"

"It helped a little bit, but now I feel sick to my stomach. My bowels are loose, too."  Your voice is quiet and defeated. This is different. . . and it scares me.

"We put you back on what you were getting at home and--"

"I know that. Soon as you said that yesterday I started. But now all I feel is sick."

"I'm sorry. . . what do you mean by 'as soon as I said that?' Do you mean the nurses told you it was a new dose?"

"What?"

"The medicines. You said you started as soon as I said something? That part confused me. Just wanted to get clear."

You reach under the bed and pull out a plastic Kroger bag full of pills. "No, I'm talking about my home medicines that you said to get back on. These here."

Wait, huh?

"Sir. . .wait. You're taking. . .hold up. . . you're taking these . . . and the ones we're prescribing in the hospital?"

"I did what you said." You point straight at me. You are talking about ME. Not my intern. Not my resident.

"What I said? You mean you are opening these bottles and taking these pills in the hospital?"

"Just the pain pills. Just those like you was talking about." You pull out a bottle and show me. "I took two of these here."

I look and then read the bottle. You have just shown me some Reglan to help with digestion. This is not a pain medicine at all. "This is what you took, sir?"

"Yes, I took my pain pills from home. That's what you said!"  Your voice is rising higher and cracking a bit. Your repeat yourself. "You said to get back on my pills from home!"

Briefly, I'm relieved that you didn't take double the amount of narcotic pain medicine, but that is only fleeting.  I squeeze my eyes and rub my forehead with the heel of my hand and sigh. "Sirrrr. . ." My voice sounds scolding, even though I don't mean for it to sound that way. "Noooo. .  .noooo. . . .you're never supposed to take your pills from home when you're in the hospital. This could really--"

That was it. That was the straw that broke the camel's back.

Your face melted into frustration and tears began shooting out of your crinkled eyes. You shriek out, "I DON'T KNOW!!! I DON'T KNOW!!!  I DON'T UNDERSTAND THIS! I DON'T UNDERSTAND THESE MEDICINES!!!"  Your body is limp and your shoulders slump. And you weep. An exhausted, exasperated, tired weep.  "I'm tired of the pain. I just want to stop my body from hurting. This illness going all through my body. . . I know it ain't a cure but they said. . . you said you would help my pain. Please, please. . . .help me."

Your hands are shaking and your lips are quivering. Each word is punctuated by your throaty cry. That cry sounded like it had been bottled up for all seven of your decades and I had just rubbed it out just like some kind of genie. It rose out into the hallway, first slithering around my head and strangling my neck.

I stood there dumbfounded.  My face felt like it was on fire and my eyes blinked like some kind of involuntary tick to fight back the rapidly forming tears. I dared not talk. I had done enough.

I reached down and patted the bed, looking at you for permission to sit beside you. You nod, still crying. . . now trickling off into restrained manly crying instead.

And so I sat next to you in silence. I held your hand and wiped your cheek with some paper towel since it was the only thing sitting on your tray table. Then, when you were ready, we started over. Going through each medicine one by one. . . opening the bottles, pouring out each pill, and making it more concrete.

You told me that sometimes it's hard to see the words on the pill bottles and that even when you can, sometimes it's hard to read them depending on the words involved.  I tell you I should have asked that and I apologize for what feels like the one hundred-trillionth time.

Then, eventually we get somewhere.  I excuse myself with your permission and share this with the other members of our team. The intern, the resident, the pharmacist, the students. I let them see how ashamed I feel and how much it hurt my heart to see you cry. Yes, you. A grown man. Their faces look sorry, too, and I say nothing to blow it over or shrug it off because you being confused and in pain and frustrated just isn't acceptable. So together, we vow to do better.


And so we do.


On the fourth day you were smiling. A big beautiful, nearly toothless smile. . . lighting up the room and even the hallway.


"How do you feel today?"


"Spectacular."


"Spectacular?"


"Spectacular."


***
Happy Wednesday.

Payback is a mother (and a father.)

names, details, etc. changed to protect anonymity. . . .

image credit

"Seem like every generation have a little more chances."

~ A Grady elder

______________________________________________________________
Sometimes, despite my Pollyanna exterior, I just don't feel like doing all the things people ask of me. I open emails and see requests for all kinds of things and check messages that query if I can be here or be there . . . .and most times. . .it's cool. But sometimes, I just want to growl.

Grrrr.

Sometimes, it gets to be a lot. A whole lot.

On those days, I just want to run out of my front door screaming, "No!" (Or to set my email with an out of office reply that simply says, "No." And nothing else.)

Yeah.

That's why I love working at Grady Hospital so much. Every time I feel this way, something happens to right my thinking and put me back on track. To snap me out of my doldrums and give my soul a charge. To remind me of how much greater all of this is than me. In that way that only Grady can.

This was one of those times.

***

In the Grady clinic:

"Okay, Mr. Felton. Let's just recap all of this. You have the appointment to get your echocardiogram of your heart, the appointment with the cardiologist, and then depending upon what they say, we'll know what the game plan is for you getting the defibrillator put in."

This is what my excellent resident, Maggie, said to one of our Grady elders the other day in the clinic. We had come back to the room after their initial encounter where, after having me repeat a few key points of the physical exam and history, we were now wrapping up the complicated visit with Mr. Felton and his heart failure.

"Alright," said Mr. Felton with a smile. Even thought we'd welcomed him to sit back in the chair, he remained perched on top of the examining table like a regal hawk. His eyes were focused on Maggie's mouth as she spoke, almost as if he was reading her lips. I stood near the door taking it all in.

Mr. Felton had been feeling more and more short of breath. We already knew that his heart was very weak from his remote use of alcohol. Heavy drinking is one of the most common causes we see of dilated hearts that don't pump right. Mr. Felton fell into that category, and it seemed that the hollow pump in his chest was trying harder and harder to poop out on him.

"Mr. Felton, you are such a wonderful patient. You get an A+ for always following the directions we give you," Maggie affirmed. They locked eyes and smiled. "Now tell me, sir. What questions do you have for me?"

Mr. Felton zipped his coat and placed his weathered cap on his head. "I reckon I'm alright," he replied.

I finally chimed in. "Sir?"

"Ma'am?"

"Your doctor was telling me that you didn't make it to these appointments when we referred you a couple of months ago. How do you get to your appointments? Do you rely on Grady transportation?"

"No, ma'am. My daughter, she brang me to all my 'perntments."

"Oh. . . .okay." I paused for a moment. "Does she live with you, sir?"

"No'm. But she do see about me every day. She was gone out of town for a few days and she normally see about my mail. It backed up some, and I thank she didn't see the 'perntments."

I loved his pronunciation of the word "appointment." It was so Grady elder of him.

Maggie, being the intuitive resident she is and a person who has worked with her very predictable attending for the last two years, saw where I was going with all of this. "Mr. Felton? Sir, I'm not sure I've ever asked you this. How far in school did you go?"

"I went to 'bout seven. I mean grade seven."

She looked at me quickly and then back at him. "Sir, are you. . .able to read?"

"Yeah ma'am. I do alright."

Maggie caught my eyes again, searching me for suggestions. I thought for a few moments and decided to explore this further.

"Mr. Felton? We were just thinking about how much stuff we asked you to do today. It sounds like the appointments and directions can be pretty confusing. How comfortable would you say that you are with reading the things we send you or better yet your mail in general?"

"You know what? Tha's a good way to put it. I can read. But I ain't too comfortable with it at all." He chuckled.

"I hear you, sir," I said with a big smile. "There's a lot of things that I can do, but I'm not too comfortable with." Mr. Felton seemed to like this, so I went on. "Like. . . .I can mow the lawn in my front yard. But I'm not exactly comfortable doing it, and would be happy to let somebody else step in and do it for me."

We all laughed.

"I know tha's right!" Mr. Felton cosigned. He seemed tickled at the image of me charging around my grass with a roaring lawn mower.

"Mr. Felton, sir," I continued, "maybe we can work harder to make sure the directions we give are such that you can do them even when your daughter is out of town. That sound okay?"

"Alright."

Maggie went into the computer, and began to do just that.

"The echocardiogram--" she stopped mid-sentence and corrected herself. "--the ultrasound of your heart that tells us how strong your heart pumps--that's going to be on the second floor on Tuesday. One o' clock. You see the heart doctors or what we call the cardiologists at three o'clock on the same day."

I felt proud of Maggie. We had discussed health literacy numerous times, and the importance of taking a "universal precaution" approach to all of our patient communication by always using straightforward language and confirming understanding. Admittedly, this part of the encounter was not unusual. Many of our patients have limited literacy, and we know for sure that this can sure make it rough to navigate your health care.

Maggie diligently wrote the times onto a sheet of paper.

"Give this to your daughter,okay?" Maggie added a few more words and handed it over to him. Mr. Felton took the paper and held it back from his eyes.

"TUES-DAY ONE PM," he slowly read aloud. "THREE PM FOR THE H-HEART DOCTOR. SE-COND FLOOR."

We all smiled. Especially him.

I studied his long, leathery, espresso-colored fingers as they trembled while holding the 8 x 11 scrawled with Maggie's words. Then, I thought about what had just happened. He had just read the instructions--aloud.

Here's the thing: Mr. Felton was two beats away from his ninth decade and had only reached seventh grade. I was surprised at how well he could read, even if he wasn't always comfortable doing it. I immediately wanted to know more of his story.

"Mr. Felton? Did you learn to read when you were a child?" I asked.

"Nawww. I didn't even start school 'til I was round eight years old," he quickly responded. We listened in silence as he went on. "I remember that first day--shoooot--that teacher put five words up on that chalk board and I didn't know what it was!" He shook his head. "Back then, they didn't always make sure you could read. And if you missed school to work, nobody came looking for you, you know?"

Damn.

"Wow," I said instead. I hung on his every word, nudging him to continue.

"See, I'm from the country. When you come of age, they needed you in the field or if'n you was a girl, to see about the other chil'ren. School wasn't no guarantee."

School wasn't no guarantee? Damn again.

As my husband says, this was "real talk."

I imagined Mr. Felton as a young tween, waking up one day and learning that his school days were up. Exchanging his knapsack for a basket and a hoe to plow the field. Just like that. Whether he liked it or not. I felt an intense wave of gratitude for the evolution of the times. For some reason, the moment moved me in a way that caught me off guard. I found myself coaching away the tears that were gathering in the corners of my eyes.

Maggie spoke up. "So, then, when did you learn to read, Mr. Felton? That was awesome the way you read that to us."

"My daughter," he responded with a proud smile. "My daughter. When she was just a little thang, she taught me how to read. She showed me how to string all them sounds together to make words. And you know she wasn't even more than nine or so when she did. She would go to school and then come home and wont me to play school with her." He laughed at the memory. "She liked to be the teacher. And she still steady bossin' her Daddy around."

This punched me in the chest and brought even more tears forward.

Your daughter? Taught you to read when she was a fourth grader?

I couldn't take it. I was officially on the tippy-tip edge of crying and knew that if I didn't get out of there, I would blow.

Mr. Felton smiled and shook his head. "Seem like every generation get a little more chances. Here you are a doctor, teaching me about my heart." He looked me in my glassy eyes, warm and genuine. The tears pushed out onto my lashes as I drew in a deep breath.

Despite being on the tippy-tip edge of crying, I reached out and grabbed his hand. I had to. I needed him to know how thankful I was, and how true his words were. I wanted him to know that I was touching and agreeing with him, and part of me wanted to be infused with his spirit and his history.

There goes another punch to my chest. I had to get out of there.

I abruptly stepped away and put my hand on the door. "Okay, Mr. Felton, let me leave. You're going to make me cry."

"Aww, now don't do that, Miss Manning," he said with a chuckle. Maggie watched me carefully, knowing that I was serious. I turned my back before he'd know I was serious, too.

I indeed excused myself from the room and waited for a moment outside the door. I allowed myself a few seconds to process that exchange. I patted the corners of my eyes, and took a deep breath.

I regrouped and headed down the hall to see more patients.

***

This morning, I am reflecting on the evolution of time and opportunities, and all that it has afforded so many people like me. I am reminding myself of why I have been charged to do all that I have to do, and I am coaching myself to do as much as I can to live up to why I am here. It's so much bigger than me.

I am picturing my father sitting across from his high school counselor in a 1961 Birmingham, Alabama office, hearing that counselor say to my seventeen year old father in the clearest way ever,

"Don't major in biology or try to go to medical school because you won't get in. Go study engineering."

And him saying, "But I'm not very good at math."

And him replying, "Well, that's what you need to study if you want to get a job and not waste your time."

I'm seeing myself as a ninth grader, working on a science project with my dad the reluctant engineer, who meticulously helped me with every detail. And me telling him that I wanted to be a doctor some day, and him telling me that I will be a doctor some day. For sure.

Then I'm thinking of all of the love that had to go into Mr. Felton raising a daughter who would not only teach her father how to read, but some sixty years later, accompany him to every doctor's appointment-- and "see about him" every single day. I recognize it as the same kind of love that went into getting me to this very moment in time where I, a young woman of color who became exactly what my childhood dreams imagined, sat across from him, an older man whose dreams were limited by ceilings made of not just glass but cement. . . . .as his doctor. The doctor my father wanted to be, but was advised that he could never become.

***

I caught a glimpse of Mr. Felton's daughter holding the door for him along with a bag, his umbrella, and most importantly, his hand on their way out.

I look down at my stiff white coat, the stethoscope folded neatly in its pocket, and all it represents. I feel renewed, recharged and indebted to those who wished they could wake up to all of the things that I don't always "feel like" doing.

In that moment, I hear his words again.

"Seem like every generation get a little more chances."


Ah hah.

The reason why I have more chances.

Reflection on a Tuesday: Black and White

pt. names, details, etc. changed . . . you know the deal, man
a "black and white" cookie, Brooklyn style

_____________

"Sir, I know that was a lot of information. I just want to be sure I did a good job explaining to you, okay? Can you tell me why we said you were in the hospital?"

"Sure, Miss Mannings. Y'all said I got pneumonia in my chest but then when you looked closer you saw a spot, too. Since I smoke, you want to be sure that it ain't more than just pneumonia and not something like a. . .cancer?" He smoothed the covers out over his long legs and rested his pecan colored arms on top of the blanket. His cheeks were covered with a smattering of moles and skin tags, likely from years of working out in the sun doing construction.

I drew in a deep breath. "Yes, sir. That's correct." I felt the need to make it sound less daunting. "But we aren't saying that what we saw looks exactly like cancer either, sir. I admit it was concerning." Great, now I'm backpedaling. "I mean, it's just that it's important to be sure, sir. That's why we are having you get that test by the pulmonologists or lung doctors. Do you remember what I said that test was?"

"You talking 'bout that test with the camera down your throat?"

I wished that his graphic description wasn't spot on, but it was. His wise sixty-something year old eyes didn't look the least bit fazed by the idea of something sounding so noxious as a "camera down your throat." Again, I wanted to dampen it a bit. "Umm, well. . .you know they do make you drowsy for the test and then carefully put this very small tube with a camera on it through your mouth to get to your windpipes. That's how they are able to see inside your lungs."

"Right. Down your throat, and then they stuff it in your breathing tube. That man said it's like a tree that they look down all the branches of. As I thank of it, I'm guessin' sometimes it ain't nothin' but leaves when they look, but sometimes it's something else growing on the tree that ain't 'posed to be there. Like cancer." He let out a nervous laugh.

I couldn't argue with his accurate description, and was admittedly quite impressed with the metaphor he used. The timing couldn't have been better--we had just had a lecture earlier that week on "Health Literacy" that was really driving home the importance of making certain that our patients understand what we are doing and saying. The lecture emphasized the need to say things in black and white, instead of chartreuse and celadon. Even though the plan itself wasn't that great for him, this was an example of a successful "teach back." The team listened quietly and seemed to acknowledge this as a teachable moment.

I turned toward the team and said, "It sounds like Mr. Chambers has an excellent understanding of what's going on with him!" I looked over at the patient and smiled. He returned the expression, but shortly after furrowed his brow and turned his lips to the side. Something was puzzling him. "Wait, Mr. Chambers--did I speak too soon?"

He chuckled and said, "Naw, I know what y'all doin' today. This my body. . .shoooot. . . you know I'm gon' know when it come to my body!" But then he narrowed his eyes and looked like his wheels were turning again. It was confusing.

So then I remembered the other health literacy guru tip that often gets forgotten. Instead of asking folks "do you have any questions," you pose the question the way I asked Mr. Chambers:

"Sir, what questions do you have for us?" I gestured to the medical student, Ania, who'd been carefully doting over him throughout his hospitalization.

I felt pretty sure that he would have at least one, especially with that puzzled expression he kept offering me. I was right.

"I don't have no questions for her," he spoke firmly while pointing directly at Ania the way Zachary points at Isaiah when I ask who did something, "but I DO have questions for you, Miss Manning."

I felt relieved that he was willing to ask what was obviously becoming a pressing question. "Okay, Mr. Chambers, go right ahead."

He stared at me for a few seconds like he was deciding on a Final Jeopardy answer, and finally broke the silence by saying, "Miss Manning, are you black or white?"

I raised my eyebrows in surprise and looked over at Ania who immediately blushed, initiating a domino effect with the rest of my all fair-skinned team.

Now here's the deal: I am not offended by this question, nor are my feathers ruffled in the least when it is asked--but the thing is that I usually see it coming. (See this post about Grady and the race to determine my race.) Furthermore, it always amuses me since when I look in the mirror, I see a black woman looking me squarely in the eye, albeit one with freckles.

"Am I black or white?" I repeated for clarity.

"Yeah. What are you?" He looked at me as if this were not a not-so-PC way of asking such a thing. For him, obviously it wasn't.

"What do you think I am?" My team couldn't figure out if I was embarrassed, amused or what. They shifted on their feet, somewhere between uncomfortable and intrigued.

He studied me for a few minutes and then said, "I was thankin' you was black, but I don't know. You sound black. If you ain't black, you sho' sound black."

My team was now crimson. I laughed out loud to lighten things up and let the team know that I was okay. "Okay, so here's the deal, Mr. Chambers. . .my mama, she's black and my daddy, he's black. Does that help?"

Instead of thinking this was cute, he sat there thinking as if I was Rumplestiltskin asking him to guess my name. He tapped his finger on his lip and sighed. Still in Final Jeopardy mode. I knew I'd need to let him off the hook.

"Mr. Chambers, I'm actually black." He nodded his head like that's what he was going to say and smiled. "Was there a reason you wanted to know this?"

"Honestly, doc? I was just curious. I just be wantin' to know stuff like that and I get real curious, and you seem cool so I figured I could ask."

"Does it make a difference to you? I mean, are you okay with a black doctor and . . .the rest of our doctors?" I nodded my head to Polish Ania, Taiwanese Emily, and the rest of our team of varied European descent.

"Oh yeaaaaaah," he laughed in the most unassuming way ever. "Don't matter what y'all is. I just be wantin' to know little stuff like that, tha's all. All y'all cool wit' me. Black, white, blue, whatever!"

Nice.


So that was that. My patient who might have a primary lung cancer--a possibility that he fully understood--did have a question indeed. It wasn't the kind of question I expected but that's what happens when you ask, "What questions do you have for me?" -- and that's what happens when you have the distinct pleasure of working at a place like Grady Hospital.