For Shanta Z.

On rounds today: Maureen M., M2, hears her first real, true, certain S3 gallop

Back to the Bedside


Don't say you hear it
if you don't
Don't say you see it
if you can't
Don't say you're with me
if you're not

Don't

Just say
I'm not sure
or even
No, I don't
hear it
see it
get it

Then

We'll go back to the bedside
and listen again
and look again
and ask again
and get it better
and get it right
together

Why?
Because someone is counting on you
somebody's mother
somebody's father
somebody's child
all of them are counting on you
to hear it
to see it
to get it
for sure

Or at least
almost sure

This means
they're also counting on me
to make sure you do

You hear me?
You see me?
You with me?

If not
I'll explain it again
and show you again
and again
and just maybe
again

Not for me
or even for you
but more for them
the ones who are counting on us

So, please--don't

Don't say you're a burden
to teach
because
you're not

Not to me

My only real burden
is when I can't

or worse

when you don't want me to


~ K.M. 6/27/2012

***

Happy Wednesday.

P.S. Maureen really did hear those heart sounds. . . AND she came on her own time during summer break to round with me--because she wanted to.

Three Things.

This pin reminds me to go "back to the bedside." Always.

Good morning.

I should be getting dressed for work right now but needed to get this out of my head and into this space. Three awesome things happened to me recently with regard to this blog. Thought I'd share.

Yesterday was the second day of our new interns' orientation. Imagine it --a room full of doe-eyed recent medical school grads all gearing up to be paged and referred to as "doctor." Surely they are all scared shitless.

I know I was.

Anyways.

Well. I was sitting in the back of someone's lecture yesterday and at the end this intern comes up to me. He introduces himself and then, in a rather soft spoken voice, explains to me that he was torn between Emory and another program. And that someone suggested he read my blog about Grady Hospital.

"That's how I made my decision--from reading your blog," he said matter-of-factly.

I thought my heart would explode.

I thanked him profusely. He then told me that the person who told him to read my blog was someone from the other excellent program that he was considering. The program director, even.  Yes. The profesora in Pittsburgh.

So I must say this:

Profesora? You are like an angel in my life. I cannot imagine not being your friend and trying to navigate being a professional without you in my corner. Thank you for constantly being on my side and reminding me of who I am. Thank you for being a role model and for inspiring me to always go "back to the bedside" with my learners and with myself. Our friendship makes me better -- both personally and professionally.

Next.

Another intern tells me that she was here for a visiting rotation and heard me give a lecture on "Professionalism and Humanism."  She said she never stopped thinking about it and found my blog immediately after. Then she simply thanked me for writing it.

Sigh.

Lastly--and wonderful though admittedly less important to me than the aforementioned--I was invited to be a panelist at "BlogHer '12."  I have since learned that this is kind of a big deal. Pretty stoked about it, actually.

Yeah, so I'll be in New York for that in August. Kind of exciting, right? Makes me feel so bona fide.

But not nearly as much as what those two interns said.

Sigh.

Okay. That's all for now. I have to go.

Thank you so much for being a part of this community with me. Really.

***
Happy Thursday.

Full of it.

as texted to me today: two ticks chilling on rounds

Medicine Nerd Textapalooza, today at 2:23 PM.

Her:  "Check this out!


Me: "DUDE! Full as a . . . .tick?"


Her:  "A deer tick!"


Me: "Holy cow! Is that real?"


Her: "Yep!"


Me: "Whoa. So cool."


Her: "Oh yeah."


*moment of silence*


Me:  "Syphilis! Syphilis! Syphilis!"


Her:  *throws down phone and runs off screaming in glee with hands waving all over*
_____________________________________________________


Okay, okay! I admit --  Syphilis has nothing whatsoever to do with ticks and tickborne illnesses.  But. This multimedia text image I received today? It just shows you the kinds of things you might get randomly texted when your good friends just happen to be Infectious Disease medicine nerds. (In addition to heartfelt campfire discussions about syphilis.)

Ah hem. I'm just saying.

***
Happy Friday.

P.S. Remind me to tell you later about how much they also love tuberculosis. *cough* Yeah. Remind me.

Ribbons.

*some names and minor details changed to protect anonymity. . . . yeah, yeah, you know. 

 "This is not a coincidence.
And far more 

than a lucky chance."

~ Stevie Wonder in "A Ribbon in the Sky"

I walked into a room today to see a patient that I'd never seen before. Well, I take that back. Technically, she was like many patients I've seen before-- a middle-aged black woman with some of the most "bread and butter" medical problems you can imagine. Diabetes. Hypertension. High cholesterol. Oh, and "a little extra weight."

That said, even though I had seen all of her problems before, it was true that I had never seen her. And so. Moments before entering her room, I'd quietly listened to this senior resident presenting her case. It was fairly straightforward. A follow up visit for all of those everyday problems, all of which seemed to be under excellent control.

I found her still sitting on top of the examining table where Farrah, her resident doctor, had left her before coming to get me. Her spine was as straight as a ruler and her hands were resting calmly on her lap.

"Good morning," I greeted her. "My name is Dr. Manning and I work with your doctor. We were just putting our heads together a bit about you and I wanted to come and meet you."

"It's a pleasure to make your acquaintance," she quickly replied.

A pleasure to make my acquaintance?

I loved the formality of her voice and the silky quality of it. Despite her nearly seven decades of talking, her vocal cords show no evidence of wear and tear whatsoever. No crackling sounds reminiscent of old 45's spinning under nickel-weighted needles. No gravelly hoarseness or wobbly tremulousness. Just this buttery smooth sound floating from her lips like silky ribbons in the sky. The pleasure was all mine. Already.

She reached her hand out and shook mine firmly. With her perched atop that table, that hand shake brought me directly into her personal space. Neither of us seemed to mind, though.

As I closed my fingers around hers, she erupted into a smile. A big, beautiful smile surrounded by nothing but confluent espresso-colored skin. And that skin was void of even the tiniest signs of aging. Not a single age spot, crinkle, or wrinkle in time to save nine at all.

Surprising that there weren't even any laugh lines considering how wide and easy that smile came on.

"Now that's just not fair. You have, like, NO wrinkles whatsoever!"

Yes. Although I had just met her, this is exactly what I said to her. That handshake welcomed me to say such a thing and that smile reassured me that this would be that kind of interaction. And it was.

"You know, my dear, I have been seeing Dr. Farrah for almost three years now. She has taught me how to eat and take good care of myself. I suppose it shows in my skin." And with that she looked right over at Farrah and beamed. She said those words sincerely, too, and focused on Farrah's young face with eyes so sure that no one dared refute that compliment.

"Well, it certainly does. And yes, Farrah is one of our very best."

"I would agree," she replied in that same liquid-smooth tone. And then she added, "Dr. Z is wonderful and a blessing to me."

A blessing. Ah, yes.

So we chatted a bit more about things fully unrelated to her health, mostly because I was so enthralled by her voice. Next, we moved on to address a concern that she'd been having. She explained that while she wasn't very worried about it, it was important to mention things to her doctor. That is exactly what she did.

So she talked and we listened. Then, based upon what she had told us, Farrah examined her as I stood beside her observing. And since Farrah is a senior resident with exceptional interpersonal and clinical skills this was all I needed to do. I quietly listened as Farrah then negotiated a plan with her patient--one that was inclusive of her patient's thoughts and not just ours.

Farrah escorted the patient off of that exam table and over to the chair beside the desk. At this point, I was beginning to feel like a bit of a third wheel. I prepared to bid this lovely woman adieu.

Taking her hand again, I told her exactly what I was thinking. "It has been a pleasure meeting you. A real pleasure." Because that is what I was thinking. It was truly a pleasure.

She smiled gently. And in that moment I imagined that every time she smiled, some kind of angel was churning that buttery voice in preparation for her next word. "I love Grady," she said. "Grady doctors saved my life so I will always have loyalty to Grady." She said these words while still holding my hand. And I am so glad she didn't let go.

"Wow," I whispered.

"Back then--the first time I came here--I had no insurance. I had been at another hospital and they were nice but sent me here. The Grady doctors carefully looked at my films and then did some biopsies that the other hospital told me I didn't need. That is how they found cancer in me and that was almost twenty years ago. They saved my life."

"Wow." I sounded like a broken record, but that was all I could think to say.

She went on. "I do have insurance now. And I will still keep coming here. I will."

Again that smile. That big, beautiful smile.

"Well, I'm glad because that way I can learn all of your skin secrets!" I teased. We all laughed.

"You know," she spoke with her face growing serious, "really you just need to be kind to people and not hold onto a lot of anger. Anger comes out of you. Makes you ugly and ages you. Just let things go. Grudges, pain, wrongdoings."  Farrah and I quickly caught each others' eyes. I could tell she loved the richness and regal quality of her voice, too. "Don't dwell over who did what to you. It will make you older than your years. You must make that decision to not harbor things inside."

And like that same 45 skipping like the nickel fell off the needle, I repeated that same word a few more times. "Wow. Wow. Wow." Because that's what I always say when I hear "a good word."

"Oh, and get your rest. Getting rest is important, too."

I smacked my forehead playfully and said, "Sleep? Uh oh!"

Farrah laughed at my response to that piece of advice and feigned a worried expression. Her upcoming Cardiology fellowship would make this one hard for her to follow, too.

"You know? People need their rest. Like how sometimes your kids don't want to wake up? Sometimes just let the babies sleep." Now she was pointing her finger for emphasis. "Sleep is important. The body needs rest and you have to give in to that. Let them sleep in sometimes. The children. And you, too. Not on a school day, of course. But other days relax a bit. Allow everyone some rest. It keeps you young."

And I just sat there with Farrah taking it all in. The wisdom, the advice, and all of the ribbons in the sky she had to offer us. I held her hand once more because she let me. And then, I excused myself from the room.

"If allowed, may I touch your hand?

And if pleased may I once again?
So that you, too, will understand. . ."

You know? There was nothing unusual about that encounter at all. At all. But for some reason, just writing about it has brought me to tears. I guess it's because getting to do this--to step inside of people's lives if only just for a few moments--is such a tremendous honor. Sigh. . . I know, I know. . . . it sounds so sappy and cliche to say that, but. . .it's true. It's so true. I mean, this was just one moment with one patient. Just one. And I get to do this all the time. Every day.

So I guess that's why I'm feeling so full right now. Because I don't take this lightly. I don't. And you know? Just sitting here at my computer recalling this one little snippet in my morning has pushed those tears straight onto the edges of my lashes.

I read something a close friend wrote and shared with me today. She said:

"Being a doctor and having the opportunity to share in patients' lives is definitely the highpoint of my professional life. . . ."

And she, a former Grady doctor, has said this kind of thing to me many, many times over. . . . marveling at the awesome amount of trust that human beings must put into other human beings for this whole doctoring thing to work. And how important it is for us to stop and think about that sometimes. All the times, actually.

Wow. Wow. Wow.

So maybe I have seen patients who look, at least on paper, a lot like this patient. The diabetes, the high blood pressure, the high cholesterol and those "extra pounds", too. And sure, maybe I have seen black-don't-crack skin before and smiles that melt my heart, too. But whenever I slow down and really savor what is unique about each and every individual--and see that meeting as an opportunity and an honor--it's always like a brand new adventure.

This time? A speaking voice poetic enough to rival Miss Maya Angelou herself. Oh, and a loyalty to Grady built on a testimony that preceded her young doctor and the one supervising her. And especially a song in her heart made up of peaceful notes that floated from between her lips . . . .unexpectedly creating ribbons in the sky of that clinic room.

All before 10 o' clock in the morning.

You know? I'm not sure if this is a coincidence. . . or even if it's far more than a lucky chance. But either way? Man. I'm just glad to be here.


***
Happy Tuesday.

Now playing on my mental iPod. . . . Mr. Stevie Wonder singing "A Ribbon in the Sky."


*sidebar random thought: I wonder if someone reading this is waaaay too young to have any idea what is meant by "a nickel-weighted needle playing a 45?"  Like, do people under 30 (other than Jameil-the-old-soul) even know what a 45 is? 

Hmmm. . . .

(The nickel or quarter sits on top of the needle as a weight. So it won't skip. Got it, youngsters?)

La profesora.

Not bad for an iPhone shot, eh?

"Sister,
you've been on my mind
Sister, we're two of a kind
So sister,
I'm keepin' my eyes on you
I betcha think
I don't know nothin'
But singin' the blues
Oh sister, have I got news for you
I´m somethin'
I hope you think
that you´re somethin' too. . . "

~ Miss Celie's Blues from The Color Purple

 _________________________________

I stood there quietly on the escalator taking in my surroundings. The airport was buzzing with happy and chatty people. Their voices were distinctly different than the Southern twangs typical of Atlanta. From the corner of my eye, I caught a boy lingering next to life sized replica of a legendary Pittsburgh Steeler, Franco Harris.  His mother suddenly realized that he wasn't next to her and hissed at him in a very midwestern-y voice, "Would you come on? Our bags still need PICKED UP!"


Our bags still need to be PICKED UP?

People in Pittsburgh kind of like the Steelers. Like, for real.

Alrighty then. 

That's when I knew for sure--I wasn't in Atlanta any more.

Shortly after I exited the escalator, I saw a man in some sort of black uniform-looking get up standing alone. His shoulders were squared and his legs were stiff; in his hands was a square sign that read: "MANNING."

"I'm Manning," I announced as relief washed over his face.  He scooped my carry-on out of my hand--which happened to be a Lightning McQueen backpack--and hustled over to get my small bag from the rotating belt before I could.  Before I knew it, we were heading away from the airport and onto the highway.

"University of Pittsburgh Medical Center, correct?"

I glanced at the itinerary on my iPhone to be sure. "Yes, sir."

"Are you here for a job interview at the hospital?" he queried.

"Um, not a job interview or anything. . ." I stopped mid-sentence before saying the next part since it felt rather silly. "Uhhh, yeah. . .I'm here as a visiting professor."

He raised his eyebrows, turned the corners of his mouth down like Robert DeNiro and gave a slow, exaggerated nod while turning the steering wheel.  That gesture spoke volumes--"visiting professor" sounded like kind of a big deal.

Visiting Professor. It felt funny saying it. See, the visiting professors that I met over the years were usually older chaps with wizened eyes and thinning gray hairs atop their head. Almost always male, although a few times I'd run across female ones. Even those were seasoned enough to have at least one foot in the retirement door.

So yeah. My good friend and former Grady doctor Shanta Z. suggested to someone that I come there as a visiting professor--despite my lack of Dumbledore-ishness.

Shanta--who'd relocated to University of Pittsburgh after her husband Fernando H. --also a former super-awesome Grady doctor--got a career opportunity that they couldn't refuse. Three years later, Shanta had become the residency program director at one of the largest programs in the country and Fernando's research was booming. And now, here I was coming to see them both on their new turf as a visiting professor.

Something about being a "visiting professor" sounded like it was too much for someone like me, so in my head I renamed myself visiting "profesora." Even though the translation still says the same thing, I like that it's decidedly feminine. That makes it feel a little warmer and fuzzier to me. And nurturing, too. Plus profesora has an added spunk that just isn't found in the English version.

Instead of staying in a stuffy hotel, I had the very best accommodations with Shanta and her family. (Yay!!) I bet regular visiting professors don't get to hear a four year old sing Christmas carols at the top of his lungs while wearing foot-in pajamas or get a five minute Tae Kwon Do demonstration by a seven year old yellow belt. No, they do not. But a visiting profesora? Yes, this is exactly what she gets.

I was a little nervous when I arrived at the hospital on Thursday morning. A room full of unfamiliar residents sat at a table looking in my direction. Looking at me and waiting for me to not only say something professorial, but additionally appearing a little confused by my not-so-professorial appearance. But they had been briefed on who I was already. My fellow profesora, Shanta, had started some sort of drum roll that I now needed to live up to.


Great.

But you know? I found out quickly that these residents were no different than I was as a resident. To them, learning was learning. They were gracious and receptive and welcoming. Plus, Shanta had spoken kind words about me in advance and it was obvious that they all held her in such high regard that I'd at least get the benefit of the doubt.

I met many wonderful people and was treated more like a family member than a visitor. Yesterday morning I gave a lecture to their Academy of Master Educators. I didn't admit to Shanta how nervous I was feeling on our drive to the hospital.  She had made me some coffee and I tried to act cool as both sipped from travel mugs. She pointed out a few Pittsburgh sights along the way; I wondered if what I felt turning in my stomach would become something more.  I didn't have the heart to tell her that talking to a room of people deemed "master educators" was giving me butterflies.

"I am so excited," she said to me genuinely. "You're going to be awesome."

But what if I'm not? 

That's what I wanted to utter but I didn't dare say it out loud. She had enough confidence in me for the both of us, so I drew from it. It was that confidence that prompted the University of Pittsburgh to bring a youngish profesora into their institution for two full days of teaching and networking. I wasn't going to dare make her have second thoughts about it.

When I initially stood before that podium I felt my pulse quickening, but then I glanced over at Shanta whose bright smile and clasped hands allayed the last of my fears. A thumbs up from my fellow profesora saying "You're going to be awesome."

And you know? When it was all said and done. . . I felt pretty awesome. I sure did.


Right now, I'm reflecting on the joy of female friendships. Every now and then, I hear a woman (or usually a girl) say that they don't really "do" female friendships. This is almost always accompanied by some smug shoulder shrug that suggests just how "over" her own kind she is. The pettiness. The back-biting. The cattiness. The . . . girl-ness.

"I don't really fool with females too much. Most of my closest friends are all guys."

Oh, whatever.

I think women need women friends. We sure do. We need them to survive and to be our best.

Now, let me just tell you. . . .I have some wonderful male friends--I do. I am not sure what I would do without people like David M. or Neil W. or Jason S. But no offense, gentleman, my friendships with you are simply not the same as the ones with my fellow girlfriends.

It's kind of like the difference between professor and profesora. Decidedly feminine. . . warmer and fuzzier and more nurturing. Not to mention it has that extra spunk, remember? I think every girl should have some girlfriends she can count on, and every guy should have some close male friends in his corner.

Sure. Harry is my very best friend--but he also has close male friends. In fact, in my pre-BHE days when I used to pray for a life's partner, I always included this -- "God, let him be good to his mother and also have close, good friends. Old friends. Loyal friends. And male friends."

Harry definitely has some female friends and I have no problem with that. But that's not what I'm getting at. I guess I'm always a bit leery of the woman who has no unrelated close girlfriends and equally suspicious of the man who has no homies. Because even though I need Harry, I need my girlfriends and the friends I've found in my sisters and my mom. And Harry needs his male counterparts just as much.

Wait--what was my point again?  I guess my point is that, yes, I came to Pittsburgh as a visiting professor. But having my friend. . .my sisterfriend and fellow profesora there to hold my hand and tell me I'm awesome gave me wings, man. It made my chest poke out a little more and made me project my voice more. And doing a visiting professorship that includes vacillating between questions about work-life balance and resident education and marriage and medical student teaching and raising boys is pretty darn cool if you ask me.

Yeah.

You know? My favorite part of the entire visit to University of Pittsburgh was hearing person after person share accolades about my friend Shanta Z. For being the amazing teacher, leader, physician and person that she is. How glad they are she is there. How wonderful her energy is. From the highest person on that University of Pittsburgh totem pole all the way to the recently hired temp assisting her in the office. Speaking words that I knew already but that I was more than delighted to hear again.

"You are doing amazing things here. I know you miss Atlanta, but you being here in Pittsburgh seems right. You are having such an impact."  I told her that right next to the Delta Airlines Curb Check-in. Because these are the kinds of words women speak to women.

"It was a hard transition," she said quietly. She paused for a moment and added, "You know? After your talk, people said to me, 'Now I see how hard it must have been for you to leave that place.'"

Those words were loaded with more than just a compliment to me. I thought about all of those people and faces in Atlanta that she left behind. Fifteen full years in a place she loved. Yes, I know it was hard. Then I saw the new ones. . . the people growing in their confidence there because of her. The enthusiasm I felt, the buzz of excitement vibrating from those being touched by her in Pittsburgh.

"This is right, Shanta. It is."

She just gripped the steering wheel and sighed hard. That sigh could have meant many things. I decided to just leave it at that.

We put my bag on the curb and smiled at each other. I gave my friend a hug and thanked her before heading into the airport. I told her how proud I was of her and she hugged me back. And we both felt encouraged. Because this? This is what real women-friends do for one another. And women know more than anyone when other women need hugged and encouraged.

Profesora. Decidedly feminine. Warmer, fuzzier and nurturing, too.

Oh. . .and with that added spunk, too-- remember?

***
Happy Sabado.

And now playing on my mental iPod. . . . a song that embodies what is special about having girlfriends.