Why.

There was a code blue on the ground floor. Weird considering no code blue is ever called there. I mean, not that they don't happen there. But it never reaches the overhead sirens since almost always it is happening in the emergency department where everyone is already there and ready.

Weird.

I was on the tenth floor when I heard it. Typically those nearby run to get there. In case they are the first responders, the rule is to try. I wasn't near. But I did wonder what it was all about. Grady is busy, though. There's lots that I wonder about. And then I go on to thinking of something else.

Yeah.

A few hours passed and I was up in a patient's room. He was an elder and I'd come back to check on him one more time. The patient in the bed next to him was talking about what he thought had happened. "Somebody got shot in front of Grady," the roommate said.

"Really?" I replied. "Oh my goodness. I didn't hear that."

A nurse in the room turned away from what she was doing and chimed in. "No. That's not true. Some young brothers pulled up with somebody who'd been shot. Dumped him right on the curb in front of Grady like some luggage and pulled off." She shook her head with hard disapproval. "That's a damn shame, right?"

"Wow." That was all I could think to say. I wondered if my family and friends had heard this on the news and were worried. "So . . .no one was actually shot in front of Grady?"

"No, I don't think so, But isn't that awful? Just throwing somebody on the ground not caring if they live or die? And pulling off before you could see what happened?" She sucked her teeth. Hard.

"You said 'brothers,'" my patient said. The nurse paused, balled up her espresso-colored fist on her hip and curled her lips at him in response. She didn't speak--instead she just cocked her head for emphasis. My patient turned back toward the television and said nothing else.

"That's just TERRIBLE." That's what the neighbor-patient said. Then he said it like five more times in case we didn't hear the first time.

"Wow," I mumbled. Again, because I still couldn't think of what else to say.

After that it was silent for a few moments. That nurse wiped my patient's fingertip pad with an alcohol wipe and pricked it with a lancet. He winced. She rubbed it in this tender way that showed that she cared about his discomfort. I liked that.

"Man. I hope the guy who got shot did okay," I finally said.

The nurse kept shaking her head angrily. Then she moved on to flushing my patient's IV line. "Me, too. Such a damn shame," she said. "Who does that?" The roommate made a few more comments about "not knowing where this world is coming to" and "letting our ancestors down."

No one disagreed.

Finally, my patient, a Grady elder, spoke:

"Look to me like them kids who dropped him off cared a whole bunch about whether he live or die. Bet you they somewhere distraught about they friend."

"Friend?" the nurse said. Her face looked disgusted and her lip jutted out. "FRIEND? With friends like that, who needs enemies?"

The Grady elder turned his head in her direction and looked at her; his face impassive. "If you didn't give a damn about somebody, would you bring them someplace where you KNOW they'd do everythang to save they life if they got shot?"

He kept his eyes trained on the nurse. We all stayed quiet. He raised his eyebrows and went on.

"Look to me like that was they man. Somebody they really cared about and hoped would be okay if you ask me." He shrugged and started fishing around in the sheets for his remote control.

I stared at him, taking in every word. I didn't want to miss a thing. The nurse was frozen in her tracks and the neighbor had (finally) stopped talking. All eyes were on the elder.

"The real question is this: Ask yourself WHY would some young brothers in a city like Atlanta feel scared to bring they friend into Grady after he got shot? WHY would they not be willing to stay long enough to make sure they friend don't bleed to death? You really thank it's 'cause they don't care?"

When nobody had a reply, he let out a chuckle and shook his head. His expression suggested how naïve we sounded.

After that, he turned his television back up and settled into The Steve Harvey Show. And didn't say another word. But you know what? He didn't have to.


Damn, I love this job.


***
Happy Sunday.

Christmas eve.

Yesterday was a good day. Poopdeck and JoLai flew in from LAX last night and came to our home as always. Everyone was in good spirits as we rode from the airport. Harry was at home burning in the kitchen and the kids were building some kind of fort to show their grandfather immediately upon his arrival. Christmas music was on every radio station--even the rap stations--and every single building seemed to have lights twinkling just so. I felt glad to be riding in a car with my loved ones headed home to more loved ones during the most wonderful time of the year.

Yup.

Harry asked me to stop by the neighborhood CVS to get something to drink with dinner. JoLai and I jumped out of the car and scurried inside to complete this "honey-do" before pulling into the home front. Dad chilled in the car rocking out to some Nat King Cole which was perfectly fine with him. One container of sweetened iced tea later and countless "remember that time when" stories, too, we headed up to the checkout counter--the only thing standing between us and the very, very awesome Christmas eve that surely awaited us.

I grabbed my receipt and turned toward JoLai. Just as I did, I saw what appeared to be a surgeon or a resident walking by in a fleece jacket embroidered with "Emory Surgery" on the front. "Uggh. He must have had to take call," I told JoLai. "I remember those days. Call at Christmas.That sucked." She nodded in acknowledgement because she remembered those years that I was there and they were all here thanks to my schedule as a resident physician.

Just then, the surgeon got a bit closer to me. I realized that I knew him; he'd been a student at Emory before going on to his graduate training.

"Hi, Dr. Manning," he said with a smile. Although he appeared a bit tired, the smile was genuine. I'd been around hospital people enough to know what a person who'd worked all day on a tough shift looked like. This was exactly the case.

I was glad when his name came to me right away. "Hey there, Steven. Merry Christmas to you."

"Thanks," he said. Again, authentically chipper. Which, to me, was surprising given the obvious reality of him having to work over the holidays. He was alone. And in his hand was a 20 oz. Diet Coke. This was a pretty big contrast to my gallon of Arizona iced tea for many and the freckle-faced kindred on my arm.

"On call for Christmas, huh?"

"Yeah. Just leaving the VA, actually."

"Oooph. I remember those days. But residency will be behind you before you know it."  I looked up toward his eyes and hoped to be at least quasi-encouraging. "Pay now, enjoy later, right?"

Instead of responding with a predictable head nod, Steven's expression softened for a moment. Then he said this:

"It's okay. At least I'm not the person who has to have surgery on Christmas eve. You know? It could be worse."

And I swear to you, this is what this young, second year, post-Christmas eve shift surgical resident said to me before taking a big swig of his Diet Coke. His words made me stop in my tracks and just stare at him. I let his words filter through my brain and trickle into my heart.

"Wow." That's all I could think to say initially. Mostly, I just looked at him incredulously. I mean, this was a second year surgical resident and it was DECEMBER. Look up "burn out" in the dictionary and his picture should be right here along with every other PGY2 resident training in the winter time.

But this wasn't the case. It just wasn't.

"Yeah. One of my attendings told me that once and it always stuck with me. It might not be fun to be on call on Christmas eve or Christmas, but it's not as bad as being the person who needs surgery on Christmas eve or Christmas."

I was still standing in the same place with my eyes trained on his. I pressed my lips together and took a big drag of air through my nostrils. "Man. That gives me some real perspective. Every single time that I took call or worked on Christmas as a resident that never occurred to me. You've really given me something to chew on. Thanks."

He offered back a lopsided shrug and smile in response. I could tell he wasn't trying to be heavy. This was just the perspective he'd chosen to embrace while caring for human beings during the most wonderful time of the year.

Dang.

"Merry Christmas again. And thanks for the good word."

Steven waved good bye and turned to head down the toothpaste and toiletries aisle. Just before disappearing he paused and said, "Hey--will this get me on the blog?"

I laughed out loud. "Will it?"

"Yes! I've been waiting to make the blog forever." We all collectively laughed, including my sister.

"Consider it done," I replied with a chuckle. "But, you know. . . every blogworthy moment has to have photographic evidence."

And with that, my sister pulled out her phone and immortalized the moment. She sure did.

After that, JoLai and I joined Poopdeck who had now moved on to Sam Cooke from the symphony hall of that locked car; the same one that swooped us around the corner to a home filled with the aroma of home cooked comfort foods and the sounds of children laughing. And I guess Steven went back to drinking his cola in between answering pages before eventually falling asleep on his couch. And during all of this, without question, somebody somewhere was getting prepped for emergency surgery. . . .

. . . .on Christmas eve.

Yeah.

***
Merry Christmas. I hope your days remain as merry and bright as possible.

This post reminded me of this one from a Thanksgiving in the hospital. It's one of my mom's favorites and is a story that grounds me the same way Steven's words did.

So not fair.

Schedule is in. November wards. Thanksgiving month. A big family month. At least in his family. But this year, not so much. Because of that schedule. On the wards. At Grady, no less. Damn. Not fair. So not fair.

Call schedule is posted on line. "Just check and see," his wife said. Too scared to even look. Just got married at the end of medical school. First Thanksgiving in this city away from immediate family and also first Thanksgiving with new immediate family--his wife. She nudges more. "Just check. And see."

He checks. He sees.

Damn.

Thanksgiving day ------> Long call.

This was before the no overnight rules for interns so this meant one thing. This meant no Thanksgiving. At least not for real Thanksgiving. Not fair. So not fair.

"I'll come to the hospital and have a meal with you in the cafeteria, okay?" his wife offered.

He decided that this was better than nothing.

Thanksgiving day. Busy, busy, busy.  Someone ate too much gravy and shook too much salt. Heart failure exacerbation. Another person forgot to get their blood pressure medications. Hypertensive emergency. One young guy couldn't say no to pecan pie. This wouldn't be such a big deal if he didn't have insulin-dependent diabetes. That admission was a doozy--diabetic ketoacidosis. One step away from what the Grady elders call being in "the diabetic coma."

"Is now good?" his wife asked.

"No. Not now. I'm getting bombed."

"Okay," she answered warmly. "I'll call you in an hour."

And she did. And it still wasn't good. So she called two more times and finally decided that this night just would not be good for quaint cafeteria dining. Visions of toasting with paper Coca-cola cups and gazing into his eyes over mystery hash faded away.

Not fair. So not fair.

"I am downstairs," she said in the most cheerful voice she could muster. "I have a plate for you. All of the classics. Everything you love."

And he scampered down the stairwell and out to the hospital entrance where his bride stood wrapped in one of his college sweatshirts over her nice sweater-dress. She extended her arms with this special offering--a plate of homecooked food.

He peeked under the foil. All of the trimmings and all of the trappings. And dessert on the side.

He hugged her tight and silenced his beeping pager. "I'm so sorry," he spoke softly. She kissed him on his scruffy cheek and scurried back to the car.

Not fair. So not fair.

So angry. Angry he signed up for this, a job that doesn't close on major holidays and that is open 24 - 7. Felt good about being a doctor. But not so good about being one that has to work on Thanksgiving day.

It was ten o'clock when he finally got around to heating up that plate. And just as the microwave beeped, so did his pager again. Damn. Not fair. So not fair.

One of the cross-cover patients. A youngish man with throat cancer. Unable to eat foods by mouth and receiving nutrition through tube feeds. He was in pain. That's all. Just wanted something more for pain.

"Okay," he said. "I can give you some morphine. Is this okay?"  And the patient nodded because this was okay. He prepared to leave the room and get back to that plate.

"You know what I wish? I wish I was eating some turkey and dressing. Or even just around people eating that kind of food. This doesn't even feel like Thanksgiving."

The intern looked around the room. No flowers or cards or balloons. No beloveds perched in bedside chairs determined to bring a festive atmosphere into the hospital. Nope. None of that. Next he looked up at the television. NFL football with a big banner at the bottom of the screen that read "Happy Thanksgiving." Beyond this, he wasn't sure if there was any other way the patient would even know it was turkey day. This made the intern feel even sadder because football was a part of his family's Thanksgiving tradition. And even his wife was a supreme trash-talker on NFL Sundays.

"My wife brought me a plate of food from her aunt's house. I haven't even touched it. I'd sit down here with you if I didn't think it would be cruel for you to see all that food."

"Do you like football?" his patient asked.

"Do I?"

"Oh, then. . .man. . . .it'd be great to have Thanksgiving together. You with your plate and me with my tube feeds."

Both men laughed. The intern thought for a moment about the offer. His pager had finally calmed down. Things seemed to be a little less crazy than before.

Why not? 

A few minutes later he returned to the patient's room where they shared Thanksgiving together. One intern and his twice reheated plate and one patient with his twice restarted tube feeds.  They shared and laughed and even talked a little trash about the New Orleans Saints. And funny thing. That pager didn't go off once.

The next day, the intern went home to his loving wife and shared a belated Thanksgiving dinner together. The next week, that patient he broke bread with passed away.

Not fair. So not fair.

***

Control.

Hey! It's my 300th post!  (Just thought I'd mention that.)

 __________________________________________________

***

"Got my own mind.

I want to make my own decisions.

If it has to do with my life. . . 

I wanna be the one in control."

~ Janet Jackson

____________________________________________________

I've been taking care of a few patients over the last few days who haven't been very nice to me.  One of them flat out told me to "Go Away, dammit!" when I tried to perform my examination on rounds today. She swatted my hands off of her and shooed me out of the room--for, literally, no reason that I could think of. 

Yeah.

I was tired from working over the weekend and from Zachary waking up repeatedly and whining while getting dressed and from Isaiah crying this morning before getting on the bus and from driving between Grady and Emory in the middle of the day for what has felt like the five trillionth time this month, so honestly? I just wasn't in the mood.  At. All.

I was alone.  There were no medical students with me or residents or even a nurse overlooking. I was super tempted to put my hand on my hip, let my backbone slip, and curl my lips. I was ultra tempted to grab up my cantankerous patient by the gown, stare at her nose to nose, and growl, "I WILL NOT go away. You WILL sit up and you WILL let me examine you and I will NOT be putting up with this TODAY! GOT THAT, LADY?!"

But I didn't.

Instead I just did what I could in between her exaggerated lip smacks and throaty insults; laying my quivering stethoscope any place that could possibly give me some answers and not a hand slap.  Okay. I'll admit that I was seething and had a rather funky attitude as I quietly told her the plan and halfheartedly asked if she had questions.

She did have one question: "Can you please just go A-WAY?" She then smacked her lips (very hard) and turned her back to me in a way so exaggerated that it looked planned and blocked by a director for a medical drama. "GO A-WAY!" she repeated.

So that's exactly what I did.

I wish I could tell you that I said something super poignant that allowed us to connect and then sing kumbaya. Nope. Not at all. I was tired. And I wasn't in the mood to be gracious.

After that patient, I went to see another patient who had decided early in his hospitalization that being nice to me or anyone else was not a priority.  He had gone from screaming and spitting mad, to eerily calm, to angry f-bombs, back to scary docile--all over a four day period. I had no idea what to expect this day, and truthfully? I wasn't even in the mood to find out.

Turns out that today was sarcasm day.

"Hey there. . .it's Dr. Manning."

"Well, well, well!  If it isn't DOC-ta Manning!"

"Hi sir. How are you feeling today?"

"Awesome! Just awesome! In fact, I could not be better!"

I cleared my throat and rubbed my neck.  "Umm, okay. Any pain today?"

"Let's see . . . .pain.  Um yeah! Everyone here is a pain in the ass! Does that count?" He gave me a sacchariny-sweet smile (complete with aftertaste.)

I pursed my lips and blew outward. Not. In. The. Mood. "Sir, are you moving your bowels okay?"

"I sure am!  But I'm not sure how since I barely eat this ridiculously disgusting diet! It's an absolute, f--ing joke. But, hey,  I am still AWESOME. Totally AWESOME."

I did my best to acknowledge the psychiatric aspects of his behavior. But it was hard today. And I won't even lie--all I could feel was annoyed. I felt myself crumbling.

"Look, sir.  This isn't helping anything. And I'm not about to stand here and listen to your profanity. I'm not. Not today, I'm not."

"Is THAT RIGHT?" he chided in an even more horribly cynical sing-songy tone.

He was totally pushing my buttons.

"That's RIGHT."

"Oh, well NEWS FLASH! I do what I WANT TO F--ING DO, ALRIGHT?"

I pressed my lips together and sighed hard.  "You know what?" I started and then stopped. It was the kind of "you know what" that precedes somebody getting cussed out on the corner or after dealing with a rude cashier.  I wanted to go straight L.A.--I take that back--straight INGLEWOOD on him, giving him back exactly what he was giving. I closed my eyes, gripped the bed rail, and tapped my foot to release the mounting frustration.

Lawd, Jesus. Help me to be more like you.  Whew.

I looked at his tray and the clear liquid diet that his condition required him to eat.  I glanced at the tubes and IV lines coming from every limb of his body. His youngish face was twisted and frustrated. His eyes narrowed and I braced myself for the venom that I saw him preparing to spew in my direction.

As I examined him, expletives whizzed past my cheeks and punched my shoulders. The worst ones you can think of. You've read all about my many tender moments at Grady--but there was nothing tender about this. At all.

In between f-bombs and grating sarcasm, I did my best to repeat the the plan to him that my team had discussed earlier that morning.

"I will speak to the specialists," I said with every drop of exhaustion that I was feeling evident in my voice. "As soon as they tell me what they recommend, someone from our team will be back to review that with you."

"GREAT, Dr. Manning! AWESOME!  Tell you what? I'll see you back in what, like, FIVE BILLION hours?!" He let out a cackle and squeezed his eyes shut.

I'm sayin'. .  . really?

I just stood there staring at him. I could feel my blood boiling.

I couldn't take it anymore. I walked out to the nurses' station, sat down and just put my head down on the desk.  I was tired. I was sick of hearing it. I closed my eyes and did my best to channel something. . .anything. . .to get me in a better place.

That's when, all of a sudden, this image of eighteen year old Janet Jackson followed by the word "CONTROL" underneath it popped into my head like a giant TV caption.

CONTROL!

Ah hah.

Kind of like Janet, that's really what we all want to some degree.  It's why Zachary was crying this morning when I wouldn't let him wear his big red rainboots to school and why Isaiah was giving me the business about wanting to be "a walker" to school and not a "busrider" and why I was so aggravated by my patients being so difficult. Control.

"If it has to do with my life--I wanna the one in control. . ."

The profanity? The refusal to cooperate? All ways to regain control for people whose unfortunate medical, social and psychiatric conditions had left them with virtually none. These two patients were frustrated with minds and bodies that had turned their backs on them -- which, truthfully, had little if anything to do with me or anyone else.

I finally admitted to myself that I was bent out of shape because I couldn't bend them in the direction I want them to go. No amount of kind words or soft intonation was working. Things that usually work for me. To control a situation.

Ah hah.

So today, despite what someone else might think was the right approach, I stopped trying. I went back in to see those two patients again; this time making up in my mind that I wouldn't make it about me. Because it wasn't.  On this day, I decided to let my patients have the control that they, too, craved by simply controlling me -- even if it meant getting pelted with a shrapnel of f-bombs, "go aways", and extraordinarily rude sarcasm-- and even if giving it to them was at the expense of just a little bit (okay, maybe a lot) of my own pride.

Funny. Once I looked at it that way, I somehow felt better about it all. And more in control.

***


"I'm in control. . . .and I love it."  ~ Janet J.