The Girl Code.

with Jada, one of my med school best friends, 2014

Every now and then I get a little crazy

That's not the way it's supposed to be

Sometimes my vision is a little hazy

I can't tell who I should trust 

or just who I let trust me, yeah

~ from TLC "What About Your Friends?"

I was talking to my student advisees today about this recent incident that has been circulating on social media and in the news. A resident physician at a hospital in Florida was caught on film after a few too many drinks verbally and physically assaulting an Uber driver. Let me tell you--it was no bueno.

Unh uh. 

Apparently, the dude who'd called (and paid for) the Uber car took out his smart phone and videorecorded her after she jumped into the car demanding it was for her. When the driver didn't oblige, she launched into a drunken tirade and even leaped into the passenger seat when the driver was trying to get away. She threw his phone in the street and called him, as the patients at Grady say, "everything but a child of God." Ha. The video went viral and the resident has since been placed on some kind of probation until the school decides how bad it all is.

Eek.

My students wanted to know my thoughts and feelings about all of this. They wondered if I thought this young woman should be expelled from her program or simply given a firm tongue lashing. Just how appalled was I? They wanted to know.

And so. I thought about it. And then I told them.

So here's the thing. Inebriated people do some really stupid things. And unfortunately, she did her stupid thing in 2016 when it's as easy as 1-2-3 to spread it to every continent in less than an hour. Honestly, I'm not so sure that this, though worrisome, is what concerned me the most. I suppose one might gather that a person who acts this ugly once given the EtOH truth serum might be ugly deep down inside. But then, who am I to make that call? Lastly, she was physically abusive. This is probably the thing that will be the most damaging in terms of her future as a resident in that Neurology program. Assaulting someone in the street and having it captured on film is not, to again quote my patients, "a good look."

Nope.

But surprisingly, none of the aforementioned things are what niggles at me the most when it comes to this. Instead, I'm most bothered by the fact that this drunken young female physician was allowed to make a fool of herself (and her family and her medical school and her hospital) for nearly five full minutes. And nobody did anything to stop her.

Let me clarify what I'm saying.

I cannot imagine that this young woman went somewhere and got this drunk alone. There's no way. Surely she was out with friends or, at least, acquaintances and had a few too many. And whomever those people were, had to see her leave. They waved goodbye and bid her a drunk-ass adieu. As drunk as she was, she certainly didn't stroll right out. Without question, this woman staggered and bumped into probably four or five people and tables before making her way to the door. And even if all of her people had left her earlier, surely there was somebody, anybody in that bar or club or whatever that noticed how drunk she was. Even a stranger should have been bothered by the sight if you ask me.

Yup.

But then, as she stood out there yelling and embarrassing herself, I wondered who else was there? Where were her girls? Or better yet, where were any women? All women know that there is a girl code that states that we aren't supposed to let slips hang from dresses, panties show in low slung pants, menstrual accidents go unnoticed, and hair to get splashed with vomit. And, sure, most of the girl code gets called into action when one is on the younger end but even still. The girl code is the girl code.

Several years ago, I was in New Orleans with friends walking down Bourbon Street. I was big and pregnant with Isaiah and had just enjoyed a delicious meal. We all heard this commotion and saw a crowd of about 15 people standing around something. We assumed someone was playing an instrument or dancing, considering this was New Orleans. But it wasn't that.

Nope.

What it was instead was a very, very drunk young woman on her knees doing the unthinkable to a slightly less drunk college-aged kid right then, right there in on that sidewalk. While a crowd hooped, hollered and snapped photos. It was horrible.

There were other girls there. They appeared to even know her and were acting incredulous with their hands to their mouths saying things like "OMG" and "Holy shit!" But they weren't doing anything. Like, at all.

Without batting a lash, my thirty-something year-old girlfriends all began screaming at her to stop it. We grabbed her under the arm and broke the whole thing up. And just like that, the cameras went away. I remember yelling out repeatedly, "What would your mother say? What would your father say? Get up!"

Well, actually I don't remember saying that. I just know my friends always tease me about that being my choice of words. But my point is that the girl code kicked in for all of us even though we didn't know her. We knew that no girl should let another girl be in that predicament and just stand by. So we didn't.

So, I guess my thought on the girl with the Uber goes to this. What the hell happened to the girl code? How on earth did this woman manage to do all of this out on South Beach or even leave any place alone and that drunk in the first place?

And sure. She should be responsible for her actions, yes. I mean, the child was thirty years old and a physician. But I just hate the thought of there being no girl code--or even guy code--anymore. I know for sure that, at some point in my life, I've been redirected or saved by it.

Maybe not to this degree, but surely at some point.

I ended that discussion by telling my students what I always tell them:

"Look. Don't embarrass me."

But this time I added something else:

"And also don't let anybody else here embarrass me or themselves on your watch. You got that?"

You know what? I think they did.

with Jada at our Med school banquet, 1996

I don't know what's going to happen with that young woman. I don't. But what I do know is that somebody, somewhere probably should have intervened--even if it wasn't any of their business. Because enacting the girl code rarely is about minding our own business. In fact, most times, it calls for the exact opposite.

Yeah.

***
Happy Hump Day

Now playing on my mental iPod. . . .a song about the Girl Code.

Turn on the light: A parable.

parable: n.  a usually short fictitious story that illustrates a moral or spiritual lesson

The house was beautiful. I mean, just looking at it from the outside you could tell that these people weren't hurting financially. At all. The lawn was professionally manicured and the garden had this intentional spray of blooms welcoming every visitor. And, if that wasn't enough, there was the solid concrete lion that sat at his regal perch right next to the brick walkway leading to an enormous pair of doors. It looked like something out of a fancy home magazine.

We rang the doorbell and the chime totally fit. I imagined some person striking a xylophone to announce our arrival. All of it elegant and flawless. I looked over at my husband and smiled. He smiled in return and added, "Daaaaag. This joint is nice." I nodded in agreement.

"Heeeeey!!!!" That's what we all said in unison when the door opened and we saw our friends standing in the vestibule. Technically, these weren't our super close-close friends and admittedly, this was our first time in their new home. But we were certainly friendly with them since they were friends-of-our-super-close-close-friends. And you know? It was all good from the jump. We felt comfortable right away.

I mean, how could we not in a house like this one?

Of course, we got a brief tour of the home and oohed and aaaahed at every detail. They'd worked hard and, like a lot of people we know, had come a long way. (Although they appeared to have come further than most.) This home was unbelievable. It was thoughtful of them to welcome us for the evening when they heard from our mutual pals that we'd be passing through town.

Yep.

That evening we had a delicious dinner and then sat around talking and laughing in their exquisite family room. The ceiling was two stories high and the walls were decorated with art from their travels all over the world. That said, we were super comfortable. Everything was so easy and laid back. The libations began flowing and the laughs got louder. We had a wonderful time.

Fortunately, no one had to drive anywhere. Our only destination was up the stairs to the bedrooms. Harry and I quickly buried ourselves in the heaping down comforters and fell fast asleep.

I'm not sure how long I was out before my unforgiving mother-of-two-babies bladder woke me. My head was still a little swimmy when I sat up on the edge of the bed and I had to remind myself of where I was. The heavy cloak of custom drapes was pulled tight. Even if there was daylight outside, it wouldn't have gotten into that room. I waved my hand in front of me but could barely see it. That room was pitch black.

There was a little nightlight on the stand next to me. I started to turn it on but knew that it might disturb Harry. That said, I couldn't see a damn thing in that room. I squinted my eye in the dark and tried to get my bearings on the direction of the bathroom. They'd pointed it out during the tour we'd had earlier but I still wasn't fully sure. I should turn on the light, I said to myself. But, again, I hated the idea of bothering my very light-sensitive husband from his slumber.

When I stood, the plush rug felt good on my bare toes. Even though I still felt a few of those champagne bubbles from earlier, I was mostly okay. I took a few steps toward the bathroom and felt like I was in a cave lined with high end carpet. The smell of lavender and jasmine wafted into my nose and though I had no idea from where it came, I imagined some elaborate candle collection on a nearby occasional table. Somewhere between the big inhalation I was taking and the door threshold, something sharp poked deeply into the ball of my foot.

"Ooooh aaah aaahh owie!" I whispered through clenched teeth. Whatever it was hurt bad enough to cause me to hop in place for a bit and then force me to walk on my heel only. I'm pretty sure I'd broken the skin but wasn't completely sure. By now, I had to pee so bad that I focused on that only.

I'm still not sure why I hadn't pulled out the slippers I'd packed. I guess it just seemed unnecessary in such a swanky house, you know?

Anyways.

Eventually, I got to what felt like a marble floor and heel-walked my way to the toilet. I tried to turn what I think was some sort of fancy dimmer light on in there but couldn't get it to work. I shrugged, flushed the commode and set back out into the darkness once more--still with my antalgic hobble and still with some slight giddiness from those generous glasses of Veuve-Clicquot. My eyes were now a little more adjusted so I could now at least see in front of me.

Suddenly, something flew across the floor in front of me. It ran straight over the top of my foot and disappeared into a dark corner. A massive cockroach? A small mouse? I wasn't sure. Either way, it startled the hell out of me--big time. To make matters worse, when I jumped, I stepped down on something slick and oily. Since my footing was already unsure, up went my legs straight into the air and WHAM! I landed on my back with a big thud. Not only did I knock the wind out of my chest, I also ended up knocking over some candles and lamps and causing a 3AM cacophony.

Whoops.

Lights came on and feet could be heard quickly thumping the floor in my direction. By the time I caught my breath and sat up, Harry and both of our friends were standing over me panting.

"Whoa! Are you okay, babe?" Harry said while reaching for my hand.

"I'm fine. I just slipped."

"Oh my God, girl!" My girlfriend looked at the bottom of my foot and then looked at the floor. She gasped and then looked at her husband. "Did you trip on something? What happened?"

"Uhhh. . .I'm not . . .uh. . . . I'm not sure. I think I slipped or was just. . .uhh. . .clumsy."

Right after I said that, out came that mammoth sized roach thing. It shot across the floor right next to my foot. Both of us ladies jumped behind the door while the guys ran after it with their shoes in hand.  Harry's foot slid a little and he nearly fell, too.

We all winced when we heard a crackling sound under the smack of that shoe. I looked over at them and spoke. "Okay, maybe I'm kind of scary and just maybe that little guy is partially responsible for that spill I took."

"Little guy?" my girlfriend said. "Good heavens."

"Oh damn! It looks like this scented oil lamp thing leaked," her husband replied. He looked over at her and sighed. "Since no one had been in this bathroom, I admit I didn't even check again." Then he looked at me. "Damn, I'm sorry, KD. This is super embarrassing."

"Girl, you just missed the edge of that tub!" She clutched her chest and shook her head. "Kim, I had no idea there was oil in here or a leak in this thing. Good Lord. If I had known, I totally would have moved that thing or gotten rid of it altogether. And as for that bug? I don't even know what to say. You could've gotten really seriously injured. I'm so sorry."

"I'm fine. Bugs are stealthy and this is the south. And I also should have turned on the light."

"Your foot is bleeding. Looks like a cut on the side of it." Harry pointed at my right foot. I pulled it closer to inspect it.

"Oh man. Forgot about that. I actually stepped on something sticking from the carpet when I was walking to the bathroom. Felt like something hard plastic. But I thought it didn't break my skin."

"Girl, you are kidding me!" She reached down and picked up a piece of a broken Lego. "I'm going to fuss at those kids as soon as they get back from their grandparents' house."

"It's no big deal. I was kind of heel walking with this foot which is the one I stuck in the oil when our little friend showed up. Pretty much a Murphy's Law kind of thing. It's actually kind of funny."

"Not to me, Kim. I'm sorry, girl." Her usually olive skin was beet red. I felt terrible for her.

After that we were all awake.  Our friends looked mortified no matter what we said. Over and over again they kept saying that they were sorry and had no idea that something was on the floor. Then they'd imagine that roach thing and fall silent. They handed me bandaids and towels and kept asking me if I was sure my foot didn't need stitches.  I kept saying that it was no big deal and that sutures weren't necessary. I also said repeatedly that I wasn't upset.

Because I wasn't. 

"Why didn't you just turn on the light?" Harry said to me later.

"I didn't want you to get upset since you were knocked out asleep," I replied. "I didn't want to wake you up." He rolled his eyes and shook his head.

"Babe. I love you. I wouldn't have cared if you turned on a light, crazy woman. Besides, you didn't even know this house."

"Gotcha. Seems silly now. I should've had on my house shoes, too. Then I probably wouldn't have freaked out so much or slipped."

"Kind of a shock to see a bug in that house, huh?"

"It just affirms what we always say--anybody who hasn't seen one of those things in their home in the south is either lying or they just moved in."

We both laughed.

"Next time, turn on the damn light and put on some house shoes, okay?"

"Duly noted."

The following morning we were standing in front of our friends' home as we prepared to go to our next destination. For whatever reason, they still seemed embarrassed. Just before getting into the car, I paused and spoke. "You know everyone has those bugs in their home, don't you?"

"You don't have to say that. I'm so embarrassed, girl. We try hard to keep our home clean."

"Ha. Seeing one in your clean, new crib made me feel better about the ones I've killed in my house. They should pay rent, those big ones. It's a bible belt thing. If you figure out a way to never, ever see one, though, let me know." I looked around at their home again. "This is still the swankiest house I've seen this decade."

She chuckled and reached out to hug me. "You guys are always welcomed."

"Great. We'll be back for sure. And y'all can come stay with us, too, although we aren't as neat."

"Deal."

****

December 1 was World AIDS Day. In honor of that day, I was asked to talk to a group of people in a pretty traditional church that following Sunday about the importance of getting tested for HIV. And then, whatever that test reveals, making responsible decisions with the results. And, yeah, I've done that before in churches and other large gatherings, too. Almost always it comes out preachy and uncomfortable. I can always see peoples' eyes glazing over and body language getting squirmy. Kind of like a teenager who's getting admonished by a parent about something or other that they'd rather not hear about.

Yeah. Like that.

So. I decided to try something new. Instead of lambasting them with scary statistics, I shifted gears to do something that I didn't think church folk would mind so much. This time, I kicked it bible-style with a parable. This parable.

I had their full attention, too. It was awesome.

Then I closed with this. (Or something close to it.)

It's funny how similar HIV is to visiting that house. Just as that house looked spotless, people can look that way, too. We drop our guard when an outward appearance seems to scream immaculate and impossible of tarnish. Slack also gets cut to people that we don't know well when they're connected to people we do know well. You assume nothing could possibly be wrong.

Right? Right.

But the truth is that you can never just look at anyone or anything and know anything for sure, can you? So the best thing any of us can do is get to know what you're dealing with first. That said, we're all imperfect. So even though we know better, we don't always make the right choices do we?

Given all of that, there are still some ways to prevent accidents even when we're too impatient to know all the details. First, avoiding anything that affects your judgment is a start. Like maybe not having alcohol might have given me the sense to turn on a light or put on some slippers. And, just maybe, I wouldn't have felt the urge to pee so badly. Or even at all.

If I'd just turned on a light and worn slippers, I could have seen where I was going. And avoided stepping on something that hurt me. With something on my feet, though the bug would have still alarmed me, I wouldn't have been limping and I probably wouldn't have slipped. Especially since I would have seen that puddle of oil from the get go.

Knowing your HIV status and the status of your partner is like turning on the light. No need to guess where you're stepping. Or depend upon somebody else to protect where you've stepped. Because even the shiniest, prettiest, newest, richest and cleanest things have surprises. And sometimes even they don't know about those surprises, do they?

I guess the other thing that stops us from turning on lights is fear of what someone else will say. Like, when I was scared of waking up my husband so bumbled about in darkness. But, of course, we all know that anyone who loves you wants you to turn on the light. As a matter of fact, if they really, really love you, they'll turn the light on for you. Yeah, they will.

Then there's our friends who wanted to disappear after that whole incident. We'd discovered some blemish in their world. But little did they know that everyone has something lurking in a floorboard, a crawl space or crevice that jumps out sometimes. The kind of things that you pay people to come and spray but that still somehow exist in spite of that. That is if you realize there's something that might require pest control maintenance.

Hmmmm.

I wanted our friends to know that seeing that bug and slipping on that floor and cutting my foot on that Lego made us admire them no less. We were still just as impressed with their accomplishments, glad about our growing friendship and eager to return. And eventually they believed us.

We need to do that with HIV.

Our friends got a good exterminator. And he told them that because they live in the south and amongst a lot of trees, that there'd always be some tiny amount of pests hiding in there. But nothing that would likely bother them or anyone else.

Nope.

So I guess HIV testing is like turning on a metaphorical light. And seeing a bug when you do isn't the end of the world. It isn't. You just need to know so that you can get into care. Then yes, you'll live with a tiny amount of virus, but it will be so undetectable that it won't bother you or anyone else.

You feel me?

The most elegant homes can have debris in them and an unwanted pest or two. Just like the most amazing people can have HIV. But a lot can be avoided by just turning on the light. Or putting on some house shoes. Or avoiding anything that clouds your judgement. Or makes you greatly feel the urge to go.

What's up in your house? What's up with the houses you sleep in? Do you know your way around? Would you be surprised by a sneaky wood roach or not shocked at all? Are you scared to turn on the lights? And if so, why is that? Is it that you're with someone who doesn't care whether or not you crash into something? Or someone who doesn't even know that there is something to crash into? Or even worse--both at the same time?

How well do you know your own house? What are you doing to protect it? Do you inspect it regularly? Do you allow someone else to make sure everything is okay? If not, why is that? What are you afraid of?

Remember: Knowing isn't the worst thing that could happen to you. Even if you find something. Not knowing always, always is. So turn on the light. Look around. And if you still aren't sure? Or if you're still too scared to turn the lights on?

For Christ's sake--put something on your damn feet.

Now. Let the church say, "Amen."

***
Happy Monday.

The pied piper of empathy.

Pleased to meet you

Hope you guess my name

But what's puzzling you

Is the nature of my game

~ The Rolling Stones

I was sitting at a lunch counter the other day chatting with one of my former small group advisees about his career interests. Gunan, who is now an intern, was rotating on the oncology service. During our conversation he told me about how much he was enjoying his experience.

"That's right in line with your chosen field of radiation oncology, right?"

"Yep."

"Good stuff," I replied.

"I think I just . . I don't know.  . I just like taking care of people with cancer."

Wait, huh?

I wasn't sure what to say to that. I mean, can a person technically like cancer? Is it even okay to say that? I wasn't so sure.

Gunan saw my wheels turning and clarified, "I've figured out what it is about cancer that makes me like it."

Like. Cancer. Uh, okay. 

I raised my eyebrows. "Oh yeah? What's that?"

Gunan paused for a moment to find his words. I think he wanted to be sure that it didn't come out wrong. After a few seconds he finished chewing his bite of sandwich and spoke. "You know what it is? People respect the cancer diagnosis. No matter who they are, they do."

I squinted my eyes at this concept which pushed him to go on.  From there he fleshed out the idea pointing out that there aren't too many other things that every person old or young fully respects like a cancer diagnosis. He described how even the most difficult patients straighten up the moment it gets uttered. Family members step in to help--even estranged ones come from the woodworks--because it's cancer. Almost like having a U.S. president walk into a room. Essentially, it's kind of like the universal last word of diagnoses.

Now this? This was a pretty thought provoking idea. And especially so since I'd never thought of diagnoses as rungs on some sort of ladder of respect.

Hmmmm.

"That's deep, man."

Lame reply, I know. But that's all I could say because this was such an interesting perspective--and one that I believe was extremely accurate.

Yep.

Gunan gave me something to really chew on that day. This idea of diseases being hierarchal and having one that is the President Obama of them all--cancer.

Heart disease is exponentially more likely to take out any person than cancer. It also has a much, much greater chance of disabling or redefining a life than cancer. And, though a lot about cancer is terrifyingly mysterious, when it comes to heart disease? Meh. Not so much. High blood pressure, obesity, inactivity, elevated cholesterol, and family history are just a few things that greatly increase the chance of a person getting heart disease. And you know? Society has done a pretty darn good job of getting that memo out.

Yup.

And sure, if someone doesn't seem so stressed about potentially getting something like heart disease, surely they'd feel the wake up call if they actually had it, right? In my experience, I'd say that answer isn't in the affirmative. While some folks definitely straighten up and fly right after a heart attack or some other cardiac event, many, many people don't. Nor do the people around them.

But cancer? That's a whole different story.

The other diagnosis that doesn't get it's full respect is HIV.  All of the aforementioned things about heart disease ring true for HIV. This virus? We know about it. Like, all about it. There are ways to prevent and treat it, too. But perhaps even more than heart disease, it gets treated like an annoying tick on a dog's butt--something to ignore or not even look for until your forced.

I've told people that they were HIV positive. I've held their hand and walked them through the process of getting into care, too. But unlike cancer, it doesn't arrive with the same amount of boundless empathy. And worse, many times it prompts people to run in the other direction.

The patients are usually somewhere between really, really adherent to all that you suggest or totally in denial. And you know? That doesn't happen so much with cancer.

Nope.

Compared to cancer, HIV, as the late comedian Rodney Dangerfield would say, gets "no respect at all."

Nope.




It's true. AIDS and heart disease just don't get the respect that they absolutely deserve, man. And don't even get me started on mental illness which really gets disrespected.

But cancer? For some reason it's on a lonely list of diseases that somehow escapes all that. Even the most ill-equipped, contentious, poorly resourced and opinionated patients and families respond swiftly to that six letter word. They become more pleasant, cooperative and agreeable. They try what you suggest and listen when you speak. It's pretty damn remarkable.

Yeah. My former advisee was totally right. And it's a fascinating observation, isn't it?

So what is it about cancer? Is it the terminal nature of many of its forms? Is it the ruthlessness of it in how it strikes or the triumph of those who overcome its prickly grasp? Is it our universal fear of it that makes us all feel some need to show strong empathy lest we awaken the cancer-gods and find ourselves stricken out of some punitive wrath? Maybe it's all of this. Or none of it. Whatever it is, there's just something about malignancy that makes everybody listen just a little bit closer, follow up a little more carefully, and immediately get onto our best behavior.

And you know? It's not just the patients and their families, either. Doctors are also in this same camp. Our empathy heightens for patients carrying a cancer diagnosis. I know for sure that this is so because I've felt it inside of me and witnessed it time and time again at Grady Hospital.

Let me give you an example.

I took care of this super-cantankerous gent named Mr. Kelly with a longstanding stronghold of alcohol abuse on my service recently. He'd been admitted several times over the years for withdrawal and complications of his alcoholism. That man had a very sick liver and never once got hospitalized on a "soft call."

Nope.

But even though he didn't walk the line on illness severity, that didn't make him nicer or uniquely appreciative of his healthcare providers. He was difficult. Due to his illness and unstable housing, Mr. Kelly's hygiene was poor and frankly, that made it unpleasant to care for him. And, if I man be frank, downright noxious. He also argued with staff and, due to fear and frustration, wasn't so nice most days. The team and nursing staff lost empathy for him. People went in only when absolutely imperative. And even though people held their eye rolls, you could feel them whenever his name came up in a discussion.

Yup.

But then he had that MRI that showed a mass on his liver. A mass with features pathognomonic for hepatocellular carcinoma--that is, liver cancer. A blood test and additional studies confirmed what we thought. Not only did Mr. Kelly have this bad diagnosis--he wasn't really a candidate for any interventions that could lead to a meaningful recovery.

Nope.

And that moment? That second when we scrolled through the MRI images and hit that big oval mass on his liver? It was a turning point. Suddenly we all began rooting for him in a different way. And I'm embarrassed to admit it but something about knowing this about him made me want to see him more and spend time in his room. The heavy cloak of foul dank odor that hit you when walking through the threshold somehow seemed insignificant now. And his "difficulties" suddenly seemed like "quirks" instead.

Yeah.

But you know? Mr. Kelly changed, too. The minute we sat in that room at eye level and shared that information, a switch turned on in him. Or off. Or whatever it was, he changed. He asked questions and listened. His family members took his calls and he took theirs. There were cards on his window sill and balloons tied to his bed rail. And the nurses, like me, in unspoken solidarity rallied around him to make sure he was comfortable and that all was well.

Yup.

One could argue that his advanced liver disease, cirrhosis and alcoholism were already equally as life threatening if not more than this new diagnosis. His life expectancy, chance for recovery from his liver damage, all of it already portended a very poor prognosis. And we, the physicians and nurse, knew that. Yet somehow when someone threw hepacellular carcinoma into the mix, we lined our ducks up and offered this man a new dignity. It's true.

And you know? I'm not sure how I feel about that. I'm not.

I talked to my friend Wendy A. about this whole concept. This idea of disease hierarchy and how some illnesses we throw our shoulders back to salute and how others get a head nod and that's it. I asked her thoughts on how cancer especially wins when it comes to that and why that was. And her take on it is that no person is exempt from the potential cancer diagnosis. She said, for this reason, perhaps, we all revere it.

Perhaps.

And I still don't know how even the ones that some cancer patients seduced into their lives through tobacco use or other finger-wag worthy habits garners the same empathy. But they do. Like, not these attitudes that the man who has sex with men got what what he had coming to him when he found out he had AIDS or how the lady who had a stroke after using crack cocaine got what she deserved. Again, regardless of the etiology, cancer escapes all that. Somehow it just does.

Yeah.

So the Pollyanna positive girl in me has decided that this speaks to some innate thread of good in all of human kind. And how, as awful as cancer can be, it's amazing that there exists something that stands out as a pied piper for humanism and care for human suffering made palpable.

Yes. That.

You know? I don't even know why I wrote about all of this. But I do know this: The complexity of what we do is mind-blowing, man.

Yeah.

***
Happy Humpday.

Now playing on my mental iPod. . . .The Rolling Stones performing "Sympathy for the Devil."  (Well technically the remix done by Pharrell but still, it's the Stones and it's awesome.)

Beyond the Sexy: Seven ESSENTIALS to look for in a residency program (or medical school.)

Am I wrong for thinking out the box from where I stay?

Am I wrong for saying that I choose another way?

I ain't tryna do what everybody else doing

Just 'cause everybody doing what they all do

If one thing I know, I'll fall but I'll grow

I'm walking down this road of mine, this road that I call home

So am I wrong

For thinking that we could be something for real?

Now am I wrong

For trying to reach the things that I can't see?

But that's just how I feel,

That's just how I feel

That's just how I feel

Trying to reach the things that I can't see

Am I tripping for having a vision?

My prediction: I'mma be on the top of the world

Walk your walk and don't look back, always do what you decide

Don't let them control your life, that's just how I feel

Fight for yours and don't let go, don't let them compare you, no

Don't worry, you're not alone, that's just how we feel

~ Nico & Vinz "Am I Wrong"

_________________________________________________________

Choosing a residency program is such a tricky thing for medical students. After working so hard, it only seems right to climb on what most would agree is the highest ladder rung attainable. In every specialty, certain programs at certain hospitals hold that distinction. Those sit high on shiny platinum pedestals far out of the reach of most. These are the ones that you utter aloud and immediately garner raised eyebrows. Not the suspicious kind but the affirming kind that say, "Daaaaaamn. It's like that?"

Yeah.

Honestly, I'm not fully sure how it all happens. And by "it" I mean a residency program becoming so sexy that everyone loses sight of the details of what really should be considered in such an important choice. The name flies so high like a gigantic flag in the sky that what it represents (or even if the place is right for a particular individual) becomes moot. Everyone wants to be down with them and thus, one of the cool kids. It isn't a far cry from middle school, actually.

Yeah. I said it.

In all fairness, I should say that there are sexy, platinum programs in every specialty that are perfect fits for certain folks and also ones filled with people dedicated to creating great learning and training climates. But I guess what I'm thinking about right now is this simple truth:

Just because a residency program, or even medical school, is the most recognizable and shiny on paper doesn't mean it is the very best one for you.

Nope.

I will never forget my residency application process. I'd done fairly well in med school and was a student leader. As an underrepresented minority to boot, sexy programs found me sexy, too. And I hope everyone is getting my use of that word--sexy. I mean it in the "it place" and "thing-of-the-moment" way. Not the Pretty Woman-knee-high-patent-leather-boots way.

Just saying.

Okay, so where was I? Oh. Yes. Me applying to residency. So yeah, I applied to these sexy places and they granted me interviews. I'd walk in and see how I felt and hope for something inside of me to ignite so I'd know. That was my experience with medical school and college. That "eureka!" feeling.  But for the majority of my residency trail, it just wasn't happening.

Ugggh.

I was flattered by the number of interviews I received. I caught planes, trains and automobiles to places that any and every person, even the non-medical ones, would recognize when they saw the name. My chest would poke out a bit and my step would pep up some, too. And that? Yeah. That was cool.

The thing, though, was that nothing ever really stood out to me. I mean, the names sure did when I told people, but when I was in my quiet time, nothing else did. And here's the thing: I know I'm scrappy and that no matter where I went, it would ultimately be fine. But some piece of me kept hoping that "being fine" wouldn't have to be the goal. I wanted to be more than fine and I kept hoping  that, just maybe, one of these places would blend the sexy with the tailor-made fit I was looking for.

It came to a head half way through yet another two day interview back in 1995. I was shuffling around in my taupe heels and feeling mostly "meh" about this program that I was supposed to be jumping for joy over. I smiled politely during the resident lunch and asked a few questions. But mostly I was lost in my own thoughts.

What was I looking for? I think up until that moment, I had only asked myself that in a general sense. Again, I was just aiming for the highest rung on the ladder; the places that would puff my parents' and my deans'  chests out and garner the eyebrow raise of approval when spoken out loud.

Yep.

But in that moment, I realized that this wasn't enough. So I began to really, truly think about it. Finally, I distilled my needs down to seven critical things--the absolute essentials without which it might be a deal breaker. And in full transparency--NO, this wasn't written down in a journal back in 1995. But I did shift my thinking to reflect these things that I'm about to share.

Hand over heart.

My hope is that by sharing them, someone who is preparing to start this process for residency--or even medical school or a fellowship--can use them as a springboard to think of their own specific needs.

Oh, and spoiler alert: It probably isn't the stuff you think it is. Although hopefully after this it will be.

Like to hear it? Here it go.

Seven ESSENTIALS to look for in a residency program, medical school or fellowship program beyond just how SEXY the name and reputation are

Need #1  Genuine interest in me as an individual

No. Not the fake kind where you shake my hand and act all nice for a few moments. I needed to feel like someone there would be genuinely advocating for me, on my team and slugging it out with me to help me succeed. That would require time over time. Interest. Sacrifice.

Yes.

How could I tell? Well, for starters, the places where folks were genuinely invested in my potential there were prepared. It was obvious that at least someone in leadership had not only read but thought about my application and how I'd fit in. Some piece of my interview day was built with this knowledge in mind, too. They made eye contact with me and listened when I spoke instead of clearly calculating their next talk point during mine.

Yes. That.

We all know it when we feel it. And we all know it when it's absent. The key is just to not ignore the truth when someone is, well, blowing you off.

Need #2  A climate that won't force me to assimilate into someone I'm not

Look, y'all. I'm a black girl from inner city Inglewood, California. My high school was pretty much 80% African-American, 15% Mexican, 5% Pacific Islander and 0% anything else---and I attended both a historically black undergraduate college and medical school. Sure, I can speak standard English as well as the best of them and my fund of knowledge isn't or wasn't inferior to my non-black counterparts.

But.

By this point, I'd had 25 years of experience at being comfortable in my own skin. I am a woman who identifies with black culture and doesn't pretend it doesn't exist. I'm down with celebrating all that is you but don't really see the need to downplay my own identity in the process. And I learned quick that not every place is good for that kind of person. I'm not one of those people who, like plain yogurt, takes on the flavor of whatever gets mixed into it. I guess I like it more when our ingredients enhance but don't overpower. But still pop out as their own to create an awesome blend. So that? That was important to me.

Yeah.

Need #3  People in leadership with whom I can identify

I'll be completely transparent and admit that it definitely was a common practice amongst my Meharry classmates and me to immediately open a brochure (this was pre-internet, remember?) and count up the black faces in the residency program and on the faculty. Yup. That said, this need isn't only about how many underrepresented minority folks there are in the midst.

Nope.

So check it. You ever meet someone or watch someone in action and think, "That person? Now that's somebody I'd like to be like." Or even, "That person? He/She is my kind of people, man." And it's cool when you say that about someone who could be a potential peer. But man, oh man is it uber-awesome to be able to say that about one of the head honchos.

Okay, so the race thing. Let me go on ahead and further address that before going further. If you are an underrepresented minority (which, in my case you should read to specifically mean black person) whether or not a place hires and retains a significant number of people who look like you should be noted. If there is only one or two total in a really big program? Well. Honestly, that doesn't portend the best prognosis for a person like me.

I'm sorry if that sounds harsh. It's true, though.

Remember in that old movie "Do the Right Thing" by Spike Lee when that character Buggin' Out rolled up in the pizza spot and asked Sal, the owner:

"Ay yo, Sal! How come it ain't no brothas on the wall up in here?"

I mean, I'm not saying you should say it like Buggin' Out did, or even at all. But you should note it if you are an underrepresented minority in 2015 thinking about going there. Am I saying DON'T go? No. But I am saying, make a note of it.

Yeah man.

Okay, so with all THAT said, here's another thing I know for sure: It is not a prerequisite for someone to share my race or gender to be one with whom I can identify. Case in point: During my interview day at the program where I trained, I had an interview with two individuals that blew my mind. Seriously, they did. And guess what? Both of them were--wait for it--white men.

Yup.

They were both enthusiastic teachers and in love with caring for patients in the indigent setting. Even though they were leaders, they were still very much entrenched in clinical care and teaching. They were nice to their secretaries (which I always notice) and they also called nearly every person they encountered by name.

Including me.

I watched them both in a teaching conference interacting with the house staff and students. What's funny is that I'd made up my mind to go to that interview strictly because I'd waited too late to cancel it--and not showing up at all would be rude. Had this happened in the email and text message era? Chile please. I would've cancelled that interview quicker than you can say Rumpelstiltskin.

Which reminds me: True story--I wore a mustard-colored blazer, black full leg trousers, a multicolored silk neck scarf and a bold red lip. Why? Because it's not like this California girl was going to actually train in Cleveland, Ohio. (Did I mention? It was snowing?) Plus this wasn't even the sexy program for Internal Medicine/Pediatrics in that city. Matter of fact, a lot of folks hadn't even really heard of it outside of the midwest and--real talk--I'd only scheduled the interview because I'd already planned to be in town for another program (the sexy one. Ah hem.)

But.

The first of those two interviews was the first time that whole interview cycle that I felt that feeling that I'd been looking for. These were folks I wanted to be like. And they struck me as the type who'd do any and everything to help me not only be like them but exceed them.

And so. I recognized this as a need. People around me that I'd want to emulate and who had the time and interest in me to let me into their worlds. And--yes--a place with a decent representation of women and underrepresented minorities at all levels. Because even as wonderful as those two guys were--and still are since they remain two of my mentors--never seeing your phenotypic reflection in anyone makes it not only lonely but hard for people there to imagine your full potential.

#truth

Need #4  Openness to innovation and new ideas

For as long as I can remember, I've always been a creative type. Someone shows me something one way and I immediately start brainstorming ways to put a different spin on it. When I don't see what I have in mind, I set out on a plan to build it (within reason, of course.) That's always been my way.

Now. Raise your hand if you know what it's like to suggest something and to have it immediately flicked down like a gnat in someone's ear. Raise your other hand if you've been in that place where every suggestion is met with either a "yeah, but. . " or some other trivializing comment that tells you in so many words to "take a damn seat and go with the status quo"--even when it's an idea worth trying.

I sure have. So, you know? I now know that I don't do so well in such situations. By the time I reached the end of residency, I knew that this would be an absolute need for whatever place signed me on as a faculty member. Room to build, man. And not just tables that welcomed me to sit at them as a leader but a climate open to me busting out my own tool kit with a team--and building some new tables.

Yep.

What I know is that some of the sexiest programs and hospitals--due to their sheer sexiness--don't really have to give a shit about you and your new ideas. They can just look at you or through you and then nudge your little idea to the back burner. No, worse than that. To the trivet behind the back burner where it will go bad and stagnant.

Do some big name places welcome innovative ideas from young faculty and trainees? You bet. But not all. And what I now know for sure is that the platinum pedestal isn't shiny enough to make up for a place that doesn't foster development of new ideas and initiatives from people other than the highest folks on the food chain. I was looking for a place where hard work and a growth mindset mean something--and where ideas are at least genuinely considered.

Do you have to go with all my harebrained schemes? Nope. But I sure appreciate someone listening long enough to think about it.

Need #5  A soft place to land and a place of redemption

Being a doctor is hard. Combine that with life and other factors and it can feel suffocating. Not having a place to turn beyond your peer group makes for some tough terrain. What I know for sure from doing this for this long is that we are all human and humans are guaranteed to get something wrong or not live up to what someone thought we would. The bible calls this "falling short" which always sounds better to me than "screwing up" don't you think?

Ha.

Either way. I want to know that if I do something and it isn't perfect or if I feel lost or lonely or burnt out or upset or overwhelmed or whatever. . . .that there will be somebody there in that hospital standing ready to support me. This is CRITICAL in residency and medical school. Without it, you can make it, yes. But it's exponentially harder and more unpleasant when you are fending for yourself.

I also know that sometimes things just aren't fair for people who look like me. I mean, it just is what it is. So one thing I always hope for is that there's someone fearless and fair high up on the food chain who isn't scared to go to bat or offer another chance should one be needed. And no. Not some hand out of a second chance. Just the same second chance afforded to everyone else.

#truth

Everybody knows that falling down isn't the issue. It's how we get back up again. Having somebody there to give you a ring of gold and redeem you sure as hell helps.

#realtalk

Need #6  Opportunities for growth and challenge--and mentors to help identify the right ones for you

Are you a researcher? Then a place with ongoing research and a track record of funding is definitely one step. But if there isn't room for you in the lab or a chance for you to get involved in something that fits for you? That's a problem. And just because U.S. News said some medical center is THE place for the thing that you were hoping to investigate, unless you have numbers 1 through 4 on this list, it's likely to be a pretty lumpy experience for you.

Yup.

Are you someone who wants to teach? The place for you needs to have the combination of teaching opportunities and mentors who are ready to show you the ropes. Ones that are involved in national organizations and regional meetings that can connect you to people and push you to the next level. Folks who've gone far enough to drop some chafe for you to pick up behind them. And who aren't so caught up in themselves that they only do things out of self interest--not YOU interest.

I should say that sexy places often have money and resources. And, honestly, opportunities do require resources. It's important to consider this--but not at the sacrifice of everything else.

Especially your sanity. Hello?

Here's a question: Are all the leaders at the place you're considering folks who've been in the position for seven thousand trillion years? Are things dynamic--in a good way? Are you interviewing with people who've been on faculty for 25+ years--but who are still at the Assistant Professor level? And for the underrepresented minorities and women, here's another question: Has there ever been a chief resident, chair, dean or program director that looks like you or that has the same number of X chromosomes as you? If you don't ask yourself that question, you should. Because chances are that you aren't the first talented woman/person-of-color to enter that place as of 2015. And you should wonder what's up with that.

Even if no one has noticed or considered it, you should. So if in 2015 you don't see any diversity in leadership? Or some history of it? Something IS up with that.

Yeah, I said it.

Look. I'm just saying--just maybe--no matter how sexy the place is--a homogenous leadership or leadership history just might be a red flag. Or at least a reddish one, depending upon what you have in mind for yourself. It could say something about the amount of opportunity there--just maybe. Especially if you don't fit the look of the homogeneity in the high ranks, nah mean?

Look, man. For somebody with leadership potential who's hungry to go further? This is a big deal. And for me, a black female with interest in such things, this was the case. Which is why this proved to be one of my 7 essential needs.

You feel me?

Need #7  High Expectations and Motivated Peers

Man. This is perhaps the most important one of all. Let me explain.

Okay, so check it. My parents expected SO much of us growing up. They had a fit when we brought home a 'B' in a class where our potential was an 'A' and they never shot down our dreams to try hard things. Expectation is a mighty motivator for young people. Over time, I began to realize it was something that, when absent, caused me to sag like a heavy load.

Yup.

They also put us in activities and challenged us with things in the presence of other kids who were striving to do well. The competition was healthy. Being an intellectual standout around those who don't challenge you can make anyone lazy or bored. And everyone knows that this never ends well.

Nope.

What else? Oh. Yes. With residency and medical school, people select you. I mean, sure, you somewhat have some say in it, too, depending upon how academically superstar-ish you are, but still. The sexiest programs have the most say. And the super-duper-sexy ones have even more say than the top percentile applicants.

Yeah, I said it.

And guess what? I'm also going to say this: Depending on the place, those academic superstars aren't immune from being tossed into a giant stack of nondescript high achievers on a roster. And given not much more than the gold star on their lapel that comes with being a member of the training program at "Sexy-everyone-thinks-it's-awesome Hospital."

Yeah, I said it.

See, just because you got straight A's and were a student leader and got on their radar doesn't guarantee that someone will be there interested in you on a daily basis, pushing you and recognizing your talent enough to expect something uniquely better from you year after year.

Did you catch that? Uniquely better.

That means they have see you. Then recognize your talents and consider you for things that might be a fit. It means checking in with you and seeing if you're following through on things and giving you a kick in the pants when you aren't. Without expectation, it can feel like no one ever knows how hard you're working or worse, they do know but don't care.

And look. Maintaining expectation is exhausting for clinician-educators and administrators. But, in my opinion, any program that isn't willing to work at this for each and every resident or student in their program or school? Well. It simply wasn't the one for me.

Nope.

So. There you have it. My seven essentials.

Oh. So what does this all mean? Well. It means that there are things far, far more important than being on the platinum pedestal "it program" list. It means that the gold star on your lapel as your only prize short changes you regardless of how dizzy with glee it makes everyone to say when asked about you.

Now. I do need to add this disclaimer:

I know some amazing, amazing human beings at sexy programs--or who trained in those sexy med schools and hospitals--who get all of this. They get that no matter what, every person--students and residents and young faculty included--want to know that someone is seeing them and being intentional about helping with their future. And no, it doesn't have to be everyone. But someone.

Someone.

So that brings it back to me and my experience. College was at Tuskegee University. I am proud of my alma mater, but would be lying if I told you that I've encountered scores and scores of fellow Tuskegee alums at my medical meetings--even all added up after nearly 15 years of going. Nope. As far as being pre-med goes, in the early 1990's when I was there, Tuskegee definitely was not a sexy pre-med choice. It was more of an engineering and pre-vet med place. But did it have #1 - #7? Damn right it did.

Next? Meharry Medical College. Teeny tiny. Historically black. And frustratingly the place that people either mispronounced or looked puzzled over when you told them that you went to medical school in Nashville but didn't attend Vanderbilt. Historic? Absolutely. Sexy? Meh. That said, I left there strong and a leader because of the nurture given to me in the form of #1 through #7.

Yep.

Then came that tricky residency choice. Did I have good interviews? You bet I did. And were a good bit of them sexy? Without question. But the place I chose was the county teaching hospital affiliate of Case Western Reserve University in Cleveland, Ohio--MetroHealth. Those who know Cleveland know that this isn't the "it" program in that city by a long shot. But once I knew what I really and truly needed to succeed and ultimately thrive, that didn't matter. MetroHealth in Cleveland, Ohio was my very first choice on my rank list--and I was delighted to open my envelope on match day and learn that I was among one of theirs, too.

And guess what? Three non-sexy choices later, here I am. Happy. Whole. Confident. And dare I say it? Pretty darn successful so far. I'm proud that these places all get credit.

The take home for any and every person reading this--especially medical students and pre-medical students--is this:

Know what's important. Don't be so caught up in a name or a brand or the reaction you get when mentioning a place that you ignore your own unique needs as an individual applicant. Don't be afraid to rank the place that feels right. You know, the one with the kind, empathic, and innovative program director in the city that you worried wasn't sexy enough or the program that is only sexy-ish. Fight the urge to count that place out. And please-- don't be tricked into thinking that, by definition, just because you performed at a high level academically that you shouldn't look into places that seem like they might have what you need in your #1 - #7--even if they aren't on THE (insert your favorite media source) Top Ten hospitals or programs.

*Eye roll*

Oh, and medical students who just matched? If for some reason you didn't get your first choice and ended up somewhere you didn't expect to get, please--for the love of God--don't show up like a wet noodle or assuming your life has ended. Don't arrive already plotting your transfer or repeatedly telling people about all that is better, shinier, sexier about the other four programs that didn't pick you. Instead, refocus your attitude. This could be the best thing that ever happened to you. Just because people don't wet their pants when you say where you're going doesn't mean it's not a great program. Look for the things in that list. Chances are, if the place has those things, it will work out great.

Take that from a Los Angeles native who spent five years in Cleveland, Ohio. And who has historically chosen places that garnered the other kind of eyebrow raises (amongst majority folks.)

Which brings me to the last point:

This was MY list of seven essential needs. While I do think that most of these are important to any and all people facing this step, maybe some don't. I would urge you to sit down and create your own list. Ponder what you need and push yourself to think of the abstract things that can't be found on program websites or your CV but that can guarantee misery if ignored or not considered.

For me those are:

1. Genuine interest in me
2. Permission to be authentic
3. Some people with whom I can identify (professionally, genotypically and phenotypically)
4. Openness to new ideas and vision
5. A soft place to land
6. Opportunities for growth
7. Great expectations

And you know what? Last time I checked, none of those were among the factors that get any place ranked  number one on any lists.

But you know what? They should be.

That's all I've got. And hey, that's just how I feel. 

***

Happy Sunday. (And congratulations on reading that entire ramble.)

Now playing on my mental iPod. . . .