I was told one thing. That your aortic heart valve was narrow and tight and that, just maybe, one day very soon you would need that valve replaced.
Aortic stenosis. That's what I was told. With clear certainty and not so much as an eye twitch or a blink. From his lips to my ears like it was the gospel. Aortic stenosis.
I entered the room alone. Armed with the gospel that I had been told about you. Aortic stenosis. I spoke to you for a few moments and talked about what was going on. "What is your understanding of what is happening with your heart valve?"
"The blood rush over it in a way that's not normal. They heart valves don't open and close like they s'posed to."
I nodded because, for the most part, that was true. It was. And I went into a description of what it all meant. Your tight and narrow heart valve. I said the words over and over again. "Aortic stenosis" this. "Aortic stenosis" that. You looked a little bit confused but when I asked if you understood you said, "I think so."
I think so.
Next I pulled my stethoscope from my pocket. Slipping the rubber tips into my ears, I looked at you and smiled. You smiled back. Then I gave the diaphragm a vigorous rub with my palm remembering that a Grady elder had told me once: "Even though it don't do much to warm it up, something 'bout seeing you try make me feel good."
So I did that. And I do that. Most times, I do.
I close my eyes and place the instrument on your chest. I follow the map of listening areas taught to me as a medical student and quietly listen for the tell tale sounds of aortic stenosis:
First a soft sssssssshhhh. Then it grows louder to a SSSSSHHHHH. Falling down quickly to the that soft hush again.
I know it when I hear it now. And so, instead of fighting to discern what it is, I am armed with experience. You patiently allow me to confirm what we both already know. My breathing slows. My hand glides with the stethoscope over your skin.
You are so cooperative and kind, I wish I wasn't alone and that a student could be beside me. To hear and learn right next to me. Aortic stenosis.
My eyes open.
Wait huh?
I am hearing sounds, yes. But they are NOT the ones I expect. I squint my eyes and listen harder (as if this changes what the ears hear.) "Can you hold your breath?" I ask. And you do.
Same thing.
A soft whoosh followed by what sounded like a deep sigh between heart sounds. Again and again I listen. And again and again, I hear the same thing.
Shit.
"They told you your heart valve was small? Like tight and stiff?"
"They told me something. I don't know if it sounded like that."
"What about a leaky valve? Did somebody say that?"
"I don't know, Miss Manning. Y'all be saying so much sometimes."
And you're right. We do.
You don't have aortic stenosis. And while you do have an issue with your aortic valve, it isn't that. And though I am not a cardiologist, I can say that right now it doesn't look like you need surgery either.
You were gracious when I told you I was wrong. You shrugged and laughed a little. Like none of it was a big deal.
While my face burned hot like coals.
This happened a while ago. But what it taught me was that, like all gospels, I need to listen for myself, examine for myself and interpret for myself. Because even though a lot of times there is no discrepancy. . .sometimes there is. When telling someone life impacting information, it's good to have at least checked for yourself before talking.
Whew. Preach, pastor.
I also learned that there is a lot we say that gets missed. Yeah, so I work at doing a better job in that area, too. Explaining until you know so. Not just think so.
Yeah.
Last I checked, you hadn't had your aortic valve replaced. You were still doing well and seeing the cardiologists regularly. Today I am hoping and praying that you know exactly why. This is what I am hoping. And that the gospel you hear is the gospel indeed.
When you work at the only hospital that turns NO ONE away? Sometimes it gets kind of busy. And on the busiest times of your busiest days? That means either be taking a few flights of stairs to save time OR stepping into an elevator filled to the brim with me and you, yo mama, and your cousin, too. (Somebody missed that.)
Ha.
Okay so check it: I was up on the 11th floor at lunchtime today and was trying to get down to the ground floor. And OH--random sidebar--while I HAVE been known to bust out 11 flights going UP the stairs, as a rule, I almost never walk DOWN anything over 3 flights. (See: Knee replacement surgery - no thank you.)
Anywho.
After what felt like 300 trillion green arrow UP elevators coming and going, I finally see that luscious red DOWN arrow light up with a "ting." The doors slowly part and all I see is racks on racks on racks of people. All heights, all weights, all ethnicities. Some in Grady uniform attire, some in street clothes, some in white coats, and one dude in a hospital gown tied like a kimono with a Newport tucked behind his ear. They were shoulder to shoulder all the way to the front.
A lady right next to the key pad offered me a quasi-apologetic shrug from across the threshold of the lift. She looked around herself and said,"Pretty packed here. Next one?"
I threw my head back and diabolically laughed in response.
Okay, I didn't really do that, but she had me confused if she thought I wasn't getting on that elevator. With no shame in my game, I slid right on in next to her. She cleared her throat and pressed her back against the wall.
Sorry, not sorry.
A man in the middle of the pack said, "When you've been working at Grady long enough, ain't no such thing as a elevator too full." A lady in a Food Services uniform chimed in, "I know that's right!" We wanted to laugh but decided against it.
The next-to-the-keypad lady was looking salty especially after our little peanut gallery commentary. I decided to try cheering her up. "You looking over at me like, 'No this doctor lady DIDN'T step her behind on this already full elevator!'" Her face immediately went from aggravated to warm. "Mmmm hmmm. . .I see you judging me. Mmmmm hmmm. But real talk, I'm hongry. Not hungry--HONGRY." That made her laugh out loud.
Which made me happy.
The door opened on 7a and two more people slipped into crevices. Then a Grady elder with a platinum combover said, "Grady the only place where a crowd in a tight space don't damn near give me a heart attack. My fear of not getting to this cafeteria got my fear of this elevator BEAT!"
Everybody howled.
We stopped on 5 with a bit of jolt. A lady lost her footing and stumbled into the middle-of-the-pack man. He steadied her with his two hands. Then--I kid you not--he threw his head back and started singing in a LOUD, TERRIBLE singing voice. "LEAN ON ME! WHEN YOU WANT LUNCH THEN I'LL BE YOUR FRIEND!"
I started clapping and joined in, "I'LL HELP YOU CARRY ON--come on, y'all!"
THEN--OMG--y'all!! EVERYBODY chimed in either singing, clapping or both.
"FOR IT WON'T BE LONG. . .TILL I'M GONNA NEED. . . . . SOMEBODY TO LEEEEEEEAN ON!"
We all exploded in cheers and laughter. Right after that, the doors flew open on the second floor and let out half of the people, including the platinum-combover man that was heading to the cafeteria. And a few moments later, the rest of us filed out on the ground floor. . . .offering these knowing smirks and giggles to one another as we slipped pass the folks trying to get on.
Best. Thing. Ever.
If you DON'T work at Grady, you'd think I made this up. But if you do? You know it's as plausible as rain on a Tuesday in Atlanta.
Love that this is the song he chose--especially because it embodies all that we do at Grady. I walked down the street humming and hearing Bill Withers smokey voice singing the rest of those words on my mental iPod:
*** "You just call on me brother--if you need a hand. We all need somebody to lean on. I just might have a problem that you understand We all need somebody to lean on. If there is a load you have to bear that you can't carry I'm right up the road, I'll share your load If you just call me. . . . call me. . .if you need a friend. . ."
Her: "You a extrovert, ain't you?"
Me: *pointed at my chest* "Me? Extrovert? Hmmm. I definitely think of myself as a lover of people. But I'm not so sure I'm a true extrovert."
Her: "Chile please. Extroverts feel at their best with people around. That's where they get all their energy. That's you."
Me: *shifting in my seat* "I'm not so sure that's what I am."
Her: "No?"
Me: "Nope."
Her: *eyes squinted*
Me: "I'm serious. Like. . .I like being alone with myself and my thoughts . . .like. . .a lot, actually. After that, I like the people parts. Because I like thinking with other people and hearing their thoughts on certain ideas, too."
Her: "So what's that make you? An introvert? You AIN'T no introvert. I don't care what you say."
Me: "Sometimes I think I'm an introvert with very good social skills. But I become an extrovert when I feel very, very comfortable and safe."
Her: *nodding head* "That make sense."
I crossed my legs and leaned back in the bedside chair. This interaction felt comfortable and safe. Maybe that's why she accused me of being an extrovert. That made the corner of my mouth turn up.. I propped my foot on a pulled down hand rail on the bed, slid on my reading glasses and pulled my patient list out of my pocket.
Her: "Miss Manning?"
Me: "Ma'am?"
Her: "Do you ever. . . get lonely?"
Lonely?
I bit the inside of my cheek and gave her question real, true thought. I closed my eyes and took an inventory of my feelings to see if "lonely" would bubble up to the top.
It did not. I realized that that was a blessing that I'd not thought of before then. Not feeling particularly lonely.
Me: "No. I don't really think so."
Her: "Even when you by yourself?"
Me: "Especially when I'm by myself. I crack myself up."
Her: "Ha ha ha . . .that's good."
The room filled again with the ambient noise of the hospital ward and the overhead television.
Her: "I ain't never been lonely a day in my life. My whole life."
Me: "Wow. Do you think it's because you're an introvert?"
Her: "Naaaaw. It's 'cause I'm a GEMINI."
I swung my head towards her and looked confused. In response, she held up two fingers at me and winked.
Her: "That's 'cause it's TWO of us. And both of us like each other."
We both laughed out loud. I gave her hand a squeeze and headed to the door.
Me: "I'll see y'all later."
Her: "You know where to find us."
"The opposite of love is not hate, it's indifference.
The opposite of art is not ugliness, it's indifference.
The opposite of faith is not heresy, it's indifference.
And the opposite of life is not death, it's indifference."
- Elie Wiesel
I was sitting in the bedside chair talking to a Grady elder. I'd finished rounding and had come back by to spend some time in the late afternoon. This was a practice I've had since my intern year, taught to me by one of my favorite attending physicians. "Just pick one person or two every day. And go and sit with them. That's it."
Best advice ever.
The television was on over our heads and was on "The Jerry Springer Show." I realized then that, were it not for moments such as this one, I'd not even know the show still aired. Two women were fighting. Allegedly, the same gentleman had fathered their children within like 2 weeks. Instead of being mad at him, they were mad at each other. The crowd was screaming and roared even louder when one person lost a clip on pony tail.
Me: "This is a mess."
Her: "Bless they hearts. Poor chil'ren."
Another woman came flying out of the audience like superman. Her arms were swinging like windmills and legs kicking in the direction of the woman holding the pony tail. The security dude on the show feigned some deep interest in holding her back. The only thing less believable was the quasi-alarmed and stunned look on Jerry Springer's face sitting in the chair across from them.
Poor chil'ren indeed.
Her: "You know what Dr. Manning?"
Me: "What's that?"
Her: "There's three kinds of people in this world."
Me: *turning my head toward her and readying myself for this good word*
Her: "There's the ones who wish you WELL, see. Then there's the ones who wish you HELL."
Me: *silence*
Her: *silence*
Me: *turning my head from the TV to her* "That was only two."
Her: "Two what?"
Me: "Two types. What's the third type?"
Her: ""Oh the last one? Those the ones who don't even see you. They the worse ones of all."
Me: "Hmmm."
Her: "See, they the ones that don't give a damn if you live, die, or fall off in a ditch never to be heard from or seen again."
Me: "Dang."
Her: "Worse than that. They don't even know you there. And they don't even know that they don't know, neither."
Me: *raising eyebrows* "Wow."
*silence*
Things on the television got calm for a moment. But then another guy came from back stage as some kind of surprise. He was reportedly the boyfriend of the two-baby daddy. The crowd went berserk again. And, once more, Jerry Springer looked fake-stunned.
Her: "You know what? I'll take a person who wish me hell over the one who don't see me any day. I'd rather you come at me fighting, kicking and trying to punch me than just walk by me altogether. 'Cause at least THEN I know you feel something."
Me: *silence, just listening*
Her: "If you hateful to me, it just say something about how you feel about your own self. So those folks I just feel sorry for and steer clear of, you know? But them ones who don't even acknowledge you?" *shakes her head* "They do the most damage 'cause you can't even change they heart. They cold as ice."
This time I moved my whole body in the bedside chair to face her. I thought about all that she'd seen in her nearly 8 decades and all of the people she'd experienced. She knew what she was talking about.
Her: "Just 'cause you look in somebody direction don't mean you see."
Me: "Wow. I have to remember that. 'Some people wish you well and some people wish you hell.'"
*pause*
Her: "And the rest you can't tell. . . . 'cause you so invisible that they don't give a shit."
"You can, you know. You can." That response surprised her. I rested my palm over the top of her hand and repeated myself. "You can."
She smiled at me and I smiled back. "You say that like you believe it."
"It's because I do."
After that, I changed the subject. We talked about her beautiful skin that lay over her high cheekbones like a brown satin sheet. I asked where she'd left her wrinkles and pretended to look under the bed and outside the door. That made her laugh.
"Guess it's just my genes," she giggled.
"I'll say," I replied.
"The rest of this in my genes, too. Like people in my family wired for strongholds."
"Yeah. My family, too."
Her eyes widened. "For real?"
"Oh yeah."
She sat there staring out of the window after that. My hand was still on top of hers and now she was holding my fingertips tightly. I let her.
"You think I can stop?"
"I think you can do anything."
"You saying that like you mean it."
"It's 'cause I do."
That soft smile crept over her lips again. I curled my lips and nodded for added confirmation.
And that was it.
I have no idea if she will overcome this addiction after this hospitalization. But here's what I do know: The tiniest spark of belief from one person can ignite a fire of change in another. I've learned that haters and naysayers can be found everywhere. I prefer to shock the shit out of people with real, true optimism.
I do.
You are not a "crackhead."
You are not a "drunk."
You are not a "homeless lady."
You are not a "psych patient."
You are none of these things. You are your possibilities. And you are a child of God.
And no. I don't always get all of this perfect. And yes, I do fall short on empathy sometimes. But mostly, I keep trying with all of my might to find the intersection in our similarities. And what I know for sure is that it is always, always there.
Always.
Only grace separates circumstances in most instances. At least that's what I think.
“Not too heavy-handed, hear?” she told her great-grandson. “You know Mama tenderheaded.” She turned to look him in his eye and he froze with the comb in his hand and nodded.
Up until then, he’d been sitting in a chair, looking bored—typical of any middle school kid asked to sit in a hospital room. He had, as the Grady elders say, “good home training.” So he knew to ready himself to speak when I walked in on my afternoon rounds. His mom glanced at him and, on cue, he stood, looked into my eyes, and shook my hand. Then he sat back down, returning to his tweenaged thoughts.
I examined the patient and then sat on the edge of the bed to speak her and the family. At some point in the discussion, my patient said, “My hair is a mess.” And again, as if prompted, that same great-grandson rose from his chair.
Yep.
A woman once told me that I needed to have a daughter since boys don’t see about their elders once they become men. As a boy mom, that used to worry me. It doesn’t any more. Because now I’ve seen enough to know that children do what they see. Boys included.
“Don’t worry, Mama,” her great-grandson replied as he resumed stroking her silver hair with a comb, “I’m tenderhanded.”
"I KNOW I almost died," he said. "My chest was hurting so bad in this way that wasn't normal. It wasn't getting better neither."
"I'm so glad you came to Grady when you did," I replied.
"You know? My friend had a heart attack just like me. Just a year older than me. He died."
His brother was sitting in a bedside chair and chimed in. "And don't forget the dude from the car wash. That dude wasn't even 50 and left his wife and like 4 kids behind."
"Ahh man. I forgot about that dude. And remember ol' dude from the Sopranos? He had a heart attack, too. And died." My patient shook his head and sighed. "That was my dude, too. I used to love that show."
The room fell awkwardly silent after that. I guess something about mentioning Tony Soprano seemed to make the possibility of death seem more real. His eyes started glistening and his face cloaked over with sadness. A tear slipped out of his eye and disappeared under his chin. He turned his head away, hoping his brother wouldn't notice.
"You know what? My dad had a massive heart attack at 56." He glanced up at me, permitting me to add another sad story to the library of cardiac sorrows. "He had to have an emergency quadruple bypass and everything."
"Damn," my patient replied. "56? That's close to my age. And your dad, too? Aaaah, I hate hearing that." I could tell he meant that.
"Yeah. But that was almost 20 years ago. Now my daddy is 74 and still round here fixing stuff and talking junk" I squeezed his hand and smiled. "You know, sir? Not every story ends with bad news, okay?"
He tried his best to smile back. "But. . .is your daddy. . . like. . . sickly?" I saw him look over at his brother, both of them bracing themselves for my answer.
I took my phone out of my pocket, scrolled through it and then showed him a recent photo of my dad. "No, sir. He is not."
He stared and stared at my daddy on that screen. "Whew. Thank you for telling me that, hear? Seem like don't nobody ever share the good news, do they?"
I stuck that on a mental post it note and vowed to remember it. Sometimes the news is bad. And Lord knows the longer we live, the more bad stories we have. But sometimes? Sometimes things work out. Sometimes they do. And those stories need to get told, too.
Me: "Are you from Georgia?"
Her: "No. I'm from Alabama."
Me: "Really? Where 'bout?"
Her: "Tuskegee."
Me: "No way!"
Her: "Yes indeed."
Me: *I lean forward and pluck my lapel for her to see my Booker T. Washington pin*
Her: "You went to Tuskegee?"
Me: "Yes, ma'am! The pride of the swift growing south!"
Her: "So you went to Tuskegee AND you my head doctor, huh?"
Me: "Yes, ma'am."
She beamed at me. And I beamed right back.
After that she asked me to take my lapel pin off so that she could see it better. I did as I was told and held it out to her in my palm. She raised my hand up to her eyes, squinted at it carefully, and rubbed her finger over it.
Her: "It was called Tuskegee Institute when I was in school there, you know. I graduated before you was even born! And probably 'fore your parents was born, too."
*laughter*
Me: "You know. . .all the folks who went when it was Tuskegee Institute call themselves 'old school.' So I guess that makes you old school, huh?"
Her: "Nah. That ain't old school. Mother and Daddy? Now THEY was old school. They was there when it was still called TUSKEGEE NORMAL"
Me: "Whoa. Tuskegee NORMAL? Now that IS old school."
Her: "Mmm hmmm. . . It was THE TUSKEGEE NORMAL SCHOOL FOR COLORED TEACHERS." She annunciated every word when she said that and then she let out a sigh. "Mmmm hmmm. You could be a teacher or a farmer--or do home economics. That's what I did. Mother, too."
After that she just sat there . . . first staring at the pin in my hand and then back up at the stiff lapel of my white coat. A complicated expression washed over her face followed by a wistful smile. Then she closed my fingers around the pin, patted my hand and gave it a loving squeeze.
My patient didn't say much more after that. But honestly? She didn't have to. I strapped her onto my back along with the rest of my ancestors and vowed to go even harder.
Damn right.
I love this job.
____________________________ The Tuskegee Song by Paul Laurence Dunbar I Tuskegee, thou pride of the swift growing South We pay thee our homage today For the worth of thy teaching, the joy of thy care; And the good we have known 'neath thy sway. Oh, long-striving mother of diligent sons And of daughters whose strength is their pride, We will love thee forever and ever shall walk Thro' the oncoming years at thy side. II Thy Hand we have held up the difficult steeps, When painful and slow was the pace, And onward and upward we've labored with thee For the glory of God and our race. The fields smile to greet us, the forests are glad, The ring of the anvil and hoe Have a music as thrilling and sweet as a harp Which thou taught us to hear and to know. III Oh, mother Tuskegee, thou shinest today As a gem in the fairest of lands; Thou gavest the Heav'n-blessed power to see The worth of our minds and our hands. We thank thee, we bless thee, we pray for thee years Imploring with grateful accord, Full fruit for thy striving, time longer to strive, Sweet love and true labor's reward.
That's what the elderly lady said to me who'd just stepped onto the crowded Grady elevator to slide in right next to me. Even though the small space was filled with passengers standing shoulder to shoulder, my very pregnant silhouette was pretty hard to miss--even under my white coat. "No, ma'am," I responded cheerfully. "This is number two."
"Boy, ain't it?"
I chuckled at her accurate assessment--one I'd heard constantly throughout my pregnancy. "Yes, ma'am. Boy number two." The elder curled her lips downward and gave her head a smug nod.
The other people riding with us turned in my direction. I could feel everyone surveying the position of my belly to see if they agreed. Another woman looked me up and down and then chimed in. "Oh yeah. That's a boy all day and all night." A few others mumbled in agreement.
And you know? Nothing about this felt intrusive to me. All of it was Grady. So very Grady.
"It's because he's sitting high, right?" I patted the side of my stomach when I said that.
"Yeah. And 'cause your face ain't all splotched up and swoll up neither. Them girls rob your beauty every time." The crowd laughed at the Grady elder's unfiltered honesty even though she didn't mean it to be funny. "But you know you gon' have to turn right back around and try for that girl, don't you? Can't leave it at two boys."
I squinted one eye playfully in her direction. "Look at you already planning the next pregnancy! But no, ma'am. I don't think a girl is in my future. I'm pretty sure we might be done after this little boy joins us."
Her face became surprisingly serious. "Oh, now you need a girl. You got to have one."
"Uhhhh. . ." I let out a nervous laugh. Then I decided to break it up with a joke. "Can't you see I cut all my own hair off so I wouldn't have to comb any heads in the morning? God knew what He was doing. He knew I needed boys."
She still wasn't smiling. "Well. You gon' get old one day. It ain't got nothin' to do with buying baby dolls or combing hair. It's your girls that grow up to be the ones that see about you when you old. Even the boys that love they mama ain't no count when you get up in age and need 'em."
Yikes.
The rest of the passengers seemed to conveniently become silent. Even though I didn't want to do it, I started sifting through my head to see if her statement held any truth. Immediately, I imagined my brother, the one who lives only four houses away from his mother--and before that was only separated from her by two houses. "My brother sees about my mother. That's not always true."
"Yo' brother married?"
I swallowed hard and wished the elevator ride would end. Her sustained gaze over the top of her wire glasses was intimidating. I couldn't think of any witty comeback so just answered her question. "He is."
"And I bet she be the one seeing 'bout your mama. I bet."
Just then I was relieved to hear the elevator ping on my floor and the doors fling open. "Well. I hope that's not true of my boys." I offered a tight-lipped smile and eased my protuberant tummy around the crowd. "Have a good day, everybody!"
That Grady elder touched my arm and looked into my eyes. Her entire hand was splayed over my the shoulder of my white coat in that way church folks do when laying hands. "God bless you and your baby, sugar. Speaking health and wellness over you and a easy delivery. In the name of Jesus!" Others in earshot joined in as an amen choir. Just when I started feel a sweet wave of emotion, she added a sucker punch. "And go on have you that girl after this one, hear? For when you get to be a old woman like me. You gon' be glad you listened to me."
I tried to respond with a polite nonverbal expression of gratitude. Mostly I felt this weird mixture of moved, awkward and lightweight offended. Even though I knew she didn't mean it as anything but endearing.
Yeah.
I always remembered what that Grady elder said on that elevator ride. Just as I'd predicted, we were done after Zachary and didn't attempt to have more children. And honestly, I've never really felt much regret about my two boy/no girl household. From the rough and tumble play to the stinky socks to the never-let-down toilet seats, I've loved it all. Truly I have. And sure. I can totally see what is special and amazing about having daughters--especially considering that I am one. But being a boy mama hasn't felt like a mistake or a regret to me. I guess it's just always felt sort of meant to be.
But.
Something about that statement of boys growing into inattentive men who "don't see about their elders" would occasionally niggle at me. Just occasionally. I'd find myself lying in bed cuddling one of the boys and saying things like, "Are you going to forget your mama when you grow up?" Only to feel my heart nearly explode when hearing the heartfelt elementary school declarations otherwise.
I'd still wonder though. In the back of my head, I would.
As silly as it sounds, subconsciously I've kept score ever since. Looking to find as many exceptions to that rule as possible in the family members accompanying in clinic or waiting at the bedsides of my patients. Eyes peeled back looking for those caring, doting, exemplary sons. And yes. There have been sons for sure. But a lot of times there were sisters and wives, too. In fact, nearly all of the times.
So me, the mom of boys, is always hoping, you know? Hoping this isn't how it is. Or, at least, hoping some wonderful women marry my manchildren by the time Harry and I get as old as that woman in the elevator.
Not even kidding.
But, see, that was before I met Mr. Moreland.
I met him in the emergency department one day when my team was on call. He was sitting in the corner with his feet crossed and resting on the edge of the stretcher like it was some kind of ottoman. He was holding on to a folded piece of the Atlanta Journal Constitution and had reading glasses on top of his head. Mr. Moreland stood up the minute I stepped over the threshold into the room. "Frank Moreland," he said shaking my hand. "I'm Mrs. Eloise Moreland's son."
"Nice to meet you, sir. I'm Dr. Manning and I'll be one of the senior doctors taking care of your mother while she's in the hospital, okay?"
"Yes, ma'am," he replied. The "ma'am" felt funny coming from him given that he was easily ten or fifteen years my senior.
Mrs. Eloise had a high fever and a urinary tract infection. Her nearly ninety year old body wasn't much of a match for it, either. She'd been brought to the emergency department confused and moaning. This was a huge change from how she'd been described at baseline.
"Does your mother live alone?"
"No, she live with me." I felt my heart leap a little and scolded myself internally for getting off focus. "She fully self sufficient, though. Real, real independent. She just prefer to not be alone, you know? So she been in my house for quite some time."
"I see. Who else is in the home?"
"It's just me and her. My wife passed a few years back and my kids all grown. But all our family all around so everybody be over there all the time. She got a lot of people looking in on her and coming to see about her."
"That's great."
"Yeah. I'm one of eight. And everybody still living 'cept my oldest sister who passed in '13. I'm the only boy, though." Again an internal pirouette for team boy-mamas.
"Did they used to call you 'brother?'"
"You know it. Still do." He took off his weathered cap and tucked it under his arm with the newspaper. Rubbing his balding head, he yawned. "All them girls and just one boy. That sho' is something, ain't it?"
It was clear that he was exhausted. But interestingly he didn't seem the least bit bitter or bothered by it. And for that, I liked him immediately. I sure did.
For several days I watched Mr. Moreland come and go. One day he'd have a fluffy fleece blanket and another day would be a hot water bottle to put under her neck. And right along with him were those sisters and grandchildren and some great-grandchildren, too. All surrounding their Big Mama with the love and attention she needed to get better. They brought in balloons and cards and rubbed her feet with salve. And all of it was awesome. It was.
But let me be clear. That manchild of hers? He was the one in charge. And Brother was anything but "no count" as my elevator companion suggested. He was conscientious, devoted and there. And it was all so natural. I loved every second of it.
On the day that Mother was discharged from the hospital, I was sitting at the nurses' station writing a note. Mr. Moreland walked up and made some small talk then clarified a few disposition concerns. Just as he prepared to step away, I spoke his name. "Mr. Moreland?"
He turned around with the discharge folder in his hand and raised his eyebrows. "Ma'am?" He never stopped calling me that.
"Can I ask you something? Or rather tell you and ask you something?" He stepped back over to the counter and positioned himself to let me know I had his full attention. And so. I went ahead and told him what was on my mind. I shared with him what that lady said to me ten years before and how seeing him with his mother had given me hope. Then I asked, "What did your mother do? I need to know her secret." I chuckled when I said it although I was only partially joking.
Mr. Moreland narrowed his eyes and sighed. "Oh now it take a village, that's for sure. But my mama loved hard on all of us. Every last one. And I was just the one in the position to move her in with me, you know? I feel sure my sisters woulda done the same. But I had more room and mama got on well with my wife. I guess I ain't never thought about it as strange."
"That lady said I needed a daughter because boys grow up to be no count when it comes to seeing about their elders."
He laughed out loud at that. "I think folk that's no count when it come to their kinfolk is no count everywhere. You ain't got to wait 'til somebody grow old to see that."
"Good point."
"I say just love 'em. Sacrifice for 'em and show them they matter to you. Like they ain't never no afterthought. When they grow up? It won't even call for no arm twisting. It'll just feel like what they 'posed to do. Like it's in order. You mark my words."
"I hope you're right. Because I'm too old to have a daughter now."
"Daughters can be no count, too."
We both laughed. "I loved watching you love on your mama." I felt my eyes starting to sting a little and rolled them skyward. "Ugh. I'm such a mush ball."
Mr. Moreland grinned wide showing the metal dental work along the sides of his back teeth. His face washed over with warmth. "Something tell me those boys of yours gon' be just fine. Don't you worry."
"You think?"
"I'm a son. And I know what it look like when a mama got love in her eyes."
After that, he tipped his cap, turned around and headed back to his mother's room to retrieve the bouquets of flowers, cards and clusters of mylar balloons. I'm super glad he did, too, because I was on the tippy-tip edge of crying. One or two even slid out.
Yeah.
I hope to grow old with Harry and need only love from my children someday. I want them to have full lives of their own. It is also my wish to forge meaningful adult relationships with them and the people with whom they partner. And now, after listening to and watching Mr. Moreland, I recognize that it isn't so much that I want them to move me in with them or deny others for me. I think it's more that I want them to evolve into the kind of empathic human beings that nurture out of love instead of burdensome obligation. And no. Not just toward aging me. But to people in general.
Yeah. That.
Something in my heart tells me that they will.
I'm a mother of boys. And you know? I'm cool with that.
Yeah.
***
Happy Friday.
Now playing on my mental iPod. . . . .
*Names and details changed to protect anonymity. You know the deal.
He was estranged from his family. No one could fully put their finger on just why that was but all of the notes in the chart underscored that fact. Even though I knew he'd been living in shelters, I wanted to hear it from him. "Where do you live?" I asked. He didn't answer.
Wait. I take that back.
He mumbled something that I couldn't understand. His eyes were at half mast when he spoke but then slowly drifted downward afterward leaving a teeny slit of the muddy whites of his eyes. And that? That was how most conversations with him went. Questions answered in shaky, garbled replies that slipped out of his mouth, rolled onto the floor and under the bed out of grasp.
Yeah.
According to the chart, he'd never been here. Well, unless you count the one fleeting visit he had to the ER triage some seven years back, he hadn't. And that made it just that much more difficult. His medical history gave us no point of reference upon which to reflect. No elaborate note from an earnest intern or dutiful social worker explaining all that had gone awry in his life and some glimmer of a clue about his mind or his world. Nope. There was none of that.
None at all.
And perhaps this wouldn't be such huge deal if he wasn't so sick. Not just sick. But sick-sick in that way that conveys an imminent demise unless some act of God occurs. The kind that calls for family members sitting around tables with long faces and troubled glances while doctors clear their throats and try their hardest to use only empathic body language. But, see, that wasn't happening in his case. Because there was no family to call.
Nope.
None. As in, not one person who could step in and help navigate all of this awful while at his side. No worried soul wringing their hands or scowling suspiciously in my direction. And especially, there wasn't any person to step in and speak up for him should his mind not allow full decision making capacity.
Yep.
By the time I came along, that's what was happening. His indiscernible speech sounded nonsensical during most interactions and had been deemed a lack of competence to make his own medical decisions. Which basically left us with tied hands since there was no one. No one at all.
Our social worker data mined and found a phone number for a granddaughter. After speaking to her once or twice, it became clear that she wouldn't be the go-to person. The follow up calls went straight to voice mail.
And so. It went very predictably day after day. Him sick-sick and muttering inaudible replies to our questions and us chasing our tails trying to figure out what to do. The overall prognosis progressively dismal, without any clear evidence of meaningful recovery anywhere in sight. So, really, death with dignity appeared to be the best option. At this point, that could be achieved only through a decision to do nothing heroic. But that? That calls for a shot-caller. A person who not only knows and loves the patient well enough to know their wishes. But especially who's also willing to step in as an advocate to assure the patient the gets the treatment they'd want. Or, in this case, doesn't get the treatment that they wouldn't want. He didn't have that, though.
Nope.
So what it meant was a full court press. Doing it all even if it was mostly futile.
And wait. Let me be clear. No, I don't fancy myself the angel of death. I do think miracles can happen. That said, since I am a believer of said miracles, I know that they don't follow rhyme nor reason and happen regardless of what we do. Otherwise it's not as much a miracle as it is an intervention, you know?
So yeah, that's my thoughts on that.
Anyways. The point of this is really what happened the last time I saw the patient on rounds. We came in and it was that same thing as always. But at the very, very end of the encounter, something happened. He said something that struck a cord and gave me pause. "I'm all out of tears today." It was still gargly but this time, it was enough for me to understand.
"Wait. What did you say?" And he repeated it. This time it was unmistakeable. I rested my arm on the rail of the bed and spoke again, this time more softly. "This is a lot, I know." And when I said that he nodded, a tear trickling from his eye and rolling under his chin.
Wait. Huh?
I paused to see if he'd say more but he didn't. "Sir? I am going to come back to talk to you some more, okay?" He grumbled an affirmative response.
We stepped out in the hall together. The interns and the med student studied my puzzled face. One finally bit and asked me what was on my mind.
"That last statement," I said. "It was abstract."
"What do you mean?" a student asked.
"I think he gets it. He knows what is going on. Like he's decisional."
One intern squinted an eye. "You think?"
"I do think."
And that was all I said.
We finished up our rounds and I returned to him as promised. This time, I pulled up a chair and sat as close to him as I could so I wouldn't miss a single word. "Hey there."
He looked both surprised and happy that I'd actually returned. He smiled, bony cheeks rising high on his face and lips so dry that they cracked a tiny tear revealing glistening drops of blood when he did.
"I came back to talk to you some more."
A string of sounds came out in response. I asked him to repeat what he'd just said and recognized it to be, "'preciate you for that." And so. I dug down deep to pull out all the patience I could to hold what I hoped could be a meaningful conversation with this man. A discussion that everyone said he was incapable of managing. Trusting my gut, trying to see if this hunch I'd had earlier that he was still in there might be true.
Yeah.
So we talked. Or rather, I asked questions and he mumbled responses. But this time I was listening more carefully and asking for instant replays on the pieces I didn't get. Eventually, he said something that couldn't be confused for anything else:
"M-m-m-my body sick. Y-y-you c-c-can't find nobody 'cause-cause-cause I bes to myself. B-b-but I'on't n-n-need nobody calling my shots. I-I-I can c-c-call'em my own self."
I asked to hear that again just make sure. And he said the exact same thing again. He sure did.
Was he a quirky man? Sure. And had his life taken the rocky terrain of never-stable housing and disconnection from family? Definitely. But that didn't mean he couldn't understand his health problems for himself and have his own say. No, it did not.
The chart had note after note that said he had no capacity to make decisions. Over and over again that's what was written. By important people with lots of knowledge in this area. And honestly, I could see how that happened to some degree. But now I knew otherwise. He was decisional. And yes, reversing all that had been said and determined about him would likely be super difficult and a huge headache.
But still.
First, I documented our conversation. Then I started dredging through what I knew would be a painstaking process with a lot of push back. Except something happened. It wasn't hard, actually. I called my psychiatry colleagues and the social workers and the physician who saw him before me and told them what he'd told me. And all of those people were happy, not prideful or resistant. Happy that this man would be able to call his own shots--for his own self.
Wow.
He was discharged the very next day to the hospice care center that he chose himself. And it was seamless and free of any road blocks. He was smiling on his way out, this time without the cracked lips since somebody had slathered them down with petroleum jelly.
I learned a simple lesson and had another reinforced. The first was that I shouldn't assume things will be difficult. I mean, it's good to be aware and pragmatic, but I'm talking about dreading something to the point of thinking it's not worth the fight. A lot of times, it isn't as impossible as it looks. I think I'll fight harder for patients given that insight recognizing that I am not the only person who wants the patient to win.
And last is one I've always known but can always stand to think about again: Listen and decide for yourself. Clinical inertia is a mighty, mighty thing. You hear things and are told things that are life changing for patients. I was reminded to not let the exhaustion of a busy service of patients make me pull back and not look and listen with my own eyes and ears.
Yeah.
I hope if I'm ever in a situation where I'm up in age and very sick-sick but deep down inside can make my own decisions about my health that someone listens to me. I hope someone somewhere fights for me to call shots for my own self. I really do. And you know what else? If my lips get chapped, I hope they rub a little Vaseline on me, too.
"Any man's death diminishes me, because I am involved in mankind; and therefore never send to know for whom the bell tolls; it tolls for thee.” ~ John Donne
It has now happened to me too many times to count. A person comes into the hospital. Our hands touch at that first meeting and our hearts connect. No, not just in some obligatory way that gets outlined in that first year med school lecture about "BEING EMPATHIC." But more in a natural way. The kind that happens when you strip down the armor of stoicism and reveal a piece of who you truly are.
Yes. So this happened to me this week. It did.
From our first encounter, I knew. I knew this patient, this person would leave me forever changed. I inwardly chuckled, knowing that it would be one of those weeks of late departures--not because of neediness on her part but my own selfish desire for more. More while I could have it. More because my patient was preparing to leave. She was.
It wasn't obvious at first. So mostly, it was just her quick wit and wisdom that created this giant magnet to which I attracted. Between laughs and reflections, I'd coordinate her care with the residents and speak to consult teams. And for every single day that she was there, I would round on her twice. First, for logistical things like pain control and management. Then, to simply close out my day. I'd drag a chair to her right side, hold her hand, and soak it in. I would and I did.
On Friday she was slowing down. Together we'd agreed upon a master plan for an intervention the following week aimed at making her feel better. But some piece of me was conflicted. "Is this what you want?" I asked her.
"What do you think?" she said.
"I think I don't want you to be uncomfortable."
"Okay. Let's play it by ear, okay? If I'm not up to it, I think you will know. And I will trust your judgement."
"I will pay attention, okay?"
"You always do, Dr. Manning."
And that was the end of that discussion.
When I stepped into her room yesterday, the lights were off. It wasn't pitch dark, but more filled with shadows and only the morning sunlight. The family was at the bedside and another consultant was there, too. My team walked in and the family, with whom I'd also developed a connection, notified us that she wasn't talking. The pain in their faces grabbed me by the neck and punched me in the chest. And that, coupled with those shadows, was telling. It was.
I went to her. Usually, I offer a subtle hello and fall back when a consulting colleague has come first, but on this day I broke the rules. She was my patient. An urgency was swelling inside of me. Something was telling me, screaming to me--"You will not get a 'two-a-day' today. You will not."
She was looking straight ahead, not speaking but appeared totally lucid. Like all of this silence was voluntary, representative of elevated thoughts and reflections. The first thing I did was touch her hand like always and move close to her face. "Hello sunshine," I murmured.
And just like that, her face erupted into an enormous smile. Relief washed over the family and even the consultant. She was still there. She was. But still. I could feel it. Her hand on this day was ice cold. Yes, her spirit was still warm, but nothing else.
Nope.
I asked her questions about her pain and nausea. She nodded yes and no appropriately and told me how she was. All nonverbal but still fully present. And so. I kept talking to her. And to the family. Fielding questions from them and all the while holding her cold, cold hand.
The consultant slipped out and all that remained was the family, my team, my patient and those shadows. More questions from the family came. Concrete queries that you ask when you love somebody. Love's myopic view doesn't allow for big picture objectivity. Not that kind of love. But what I've learned is that some piece of this love category, that is, the doctor-patient love category, leaves the sliver of insight that gets lost in other kinds of love. And now that I know this, I have to use it. I must.
So, I try. I try to talk but my face. It starts to get boiling hot and those tears. Those pesky tears they pour from my eyes. My voice cracks and I feel her icy hand tighten around mine like a vice grip. She knows. Her clasp stabilizes me. She gives me courage to be honest and transparent. And so I do.
I give her hand an affirming squeeze to let her know I got the marching orders. Then I turn to her daughter. "Tell the family to get here. Get them here. Today. Now. To love on her. Love hard on her like she loved on all of you." And then I started weeping outright. And because she was holding my hand, I couldn't even wipe the tears fast enough since that would have been a two-hand job.
"Love on her," her daughter repeated while holding my gaze. "Love on her."
"Yes. It's all we have. Love is the what."
There wasn't much more to say after that. Our rapport was good and my patient's response was obvious. I leaned in to tell her good bye and asked once more if she needed anything. She nodded yes to pain medicine and no to nausea medicine. "Okay," I told her. "I got you."
And then, just like that, she spoke. "You look so beautiful." Her voice was clear. Nothing garbled or suggesting confusion. Sure, direct, clear. And those words? They were a gift. Not just to me, but to her family. They needed to know that she was there.
Shortly after that, my team left. Sujin, the third year medical student broke down crying and I consoled her in the hall. And my intern Sonali did the same. "Let it hurt. You want to be affected," I told them. "And don't let anyone tell you otherwise." Then, all of us just stood there in quiet awe of the amazing privilege we'd been given as the caregivers to this soul. We sure did.
A nurse saw us walking up the hall afterward. She asked me, "What happened? Did your patient expire?"
I smiled with my red face and snot-filled nose and replied. "No. We are just feeling fortunate to be her doctors. That's what you see." That is exactly what I said. Because it was true.
My patient passed away yesterday. Only a few hours after that encounter. That family got to her and they were all glad they did. Sonali, the intern caring for her, loved her, too, so returned to the hospital. That sweet intern sure did. And all of it was good. It was.
I'm so glad my boundary issues allow me to feel this way. My chest is heaving as I write this, but in the very best way. We are all connected, I think. Being aware of it and surrendering to it is the issue. That's what I think.
Yeah.
During one of our late afternoon handholding sessions, my patient asked me to write about her when she transitioned. I promised her I would. And so today, I honor that promise and also present a piece of her love to you. Because love? Love doesn't expire. And love, my friends, is the what.
***
Happy Sunday. And thank you for Angella for that beautiful mantra that I say or write somewhere nearly every day.
My patient took off her glasses and said, "I can't keep looking through these rose-colored glasses. I just can't."
I was holding her hand and both of us had tears in our eyes. Her body was sick and she knew it. I felt sad because there wasn't any other treatment to offer.
Then, all of a sudden, she looked at me and smirked. "You know what? I just noticed that these ol' glasses of mine really are rose-colored!" She threw her head back and laughed so hard that I did, too.
After that, we just sat in silence. Holding hands, looking out the window, and wishing on invisible stars.
"Where are you from? You aren't from Georgia," I said. His musical accent was a dead give-away.
"Guess," he replied.
"Louisiana. Totally." We both sat there smiling right after I said that. He then gave me a slow thumbs up and nodded.
"All day and all night, baby."
"Couldn't miss it," I added with a chuckle.
"This accent saved me."
"Yeah?" I raised my eyebrows, intrigued by what I'm sure was a piece of his story. I leaned into my palm and rested my elbow on the desk.
"I came here after Katrina. Didn't have a pot to piss in or a window to throw it out of. And I ain't exaggerating neither, baby. I'm talking the clothes on my back and nothing else."
"Family? Did you have any here?"
"Nope. That's where I ain't like most folk from Looziana. My family small, a lot of 'em out in the country and don't have nothing to help. Plus, I was a city cat, you know? I needed a city. So one of them church groups had a bus coming here and I got on it. Ain't had plan the first of what I'd do once I got here."
"Wow. So how did the accent save you?"
"I was in a shelter. For just one night and it was so, so terrible. Bugs, rats, people yelling and screaming and fighting. Had to get up out of there, baby. I had about forty dollars and blew it all on a cheap hotel room that night. Said I'd get me some rest and then go try to make something happen. Didn't have one dime when I checked out of that room. Not even a bottle of water on me."
"Then what happened?"
"Saw this man with a delivery truck outside of McDonald's. Walked right up on him and said, 'Brother, I need some help. I need to work. Give me a chance and I'll load everything off this truck faster than you can say shrimp etouffe."
And, okay. He didn't actually say "shrimp etouffe" but, admit it, it sounds better for the story.
Anyways.
He goes on to tell me about how the dude at the McDonald's truck said that he wasn't the boss but, like me, heard that sing-song accent and asked him where he was from. And that man said New Orleans and then shared his story. The truck man then took out his cell phone and called up a friend. "My man got this moving company. He could use some good folks to help him." That's what my patient told me the guy at McDonald's told him.
"So the guy hired you?" I asked.
"He had me meet him a few blocks over and said, 'Look, bruh. I'm gon' have you work today and see how it go. If that go okay, we'll go with tomorrow.' And I shook his hand and said, 'Hell yeah, man.' Then I worked my ass off. Moved that shit off that truck in two seconds flat."
"That's awesome."
"It is. Been working with that man ever since. Got me a house and a car and even drive the delivery truck out of state for the company. We doing good, too. Real, real good."
"I love that. Did you ever see the guy from McDonald's again?"
"You know what? Like once or twice. But I told that man that he saved my life. Just 'cause he was interested in the way I talked. Which is crazy because every time I left New Orleans, I used to wish I didn't talk so funny. But now I love my accent. Love it 'cause I know it start up conversations, you know? And conversations lead to relationships. And relationships lead to chances."
I shook my head, then stopped and nodded it hard. "Damn. That's a good word, sir."
"Yeah, it is. It don't take much. What make us feel like outsiders is what open doors to being insiders. Crazy how it all work, ain't it?"
"I remember," she said, "the day when it crossed into something else. Into that freakish range where mothers hiss to their kids to stop staring. At first you think that, just maybe, it's an accident. Then you realize that it isn't. They're whispering and pointing at you."
I squinted my eyes and tried to imagine it. My patient, minding her own business and moving slowly through the aisles of a store. Maybe even doing something like picking up lightbulbs and hand towels in the home improvement section at Target. People walking by and doing those not-so-subtle double takes and her trying her best to not notice it. But she was right. This was more than just a little out of the range of normal. And though I wouldn't choose a word like "freakish" to describe it, I'd be lying if I said that it didn't somewhat fit the definition of that word. Even if it sounds mean to think that way.
Sigh.
Patients like her require special provisions. They bring in a special bed aptly or rather, horribly, referred to as a "big boy bed" to accommodate such a large body. It's hard not to hitch your breath and stare for a beat when you first see her and others of her body habitus. Legs easily larger than my husband's torso and a mid section that appears far to heavy to be supported even by those extremities. The adult in you tries not to see the large pannus lying flaccid over their thighs and fights those silly juvenile thoughts like, "What happens when it's time to go to the bathroom?" or, I'm even more embarrassed to admit, "How would she or he make love? " I timidly raise my hand and admit that I do have these fleeting thoughts. The adult in me flicks them away. But every time, they appear and require that flick.
Yeah.
This encounter with me certainly wasn't helping her self image. My patient had some shortness of breath and was, literally, too big to receive any of the diagnostic studies that we'd considered. She could not have a CT scan. Her circumference exceeded that of the scanner and her weight was more than 150 pounds beyond the limit of the table. A stress test or a even an echocardiogram would be so limited in accuracy that it was almost deemed futile and a waste of her money and time to pursue. And to make matters worse, even if a stress test did find even some equivocal result, the cardiac catheterization lab wouldn't be able to handle 650 pounds on their support structure either.
Nope.
Ever since I was a resident physician in Cleveland, Ohio back in the 1990's, this kind of issue has periodically come up. Without fail, no matter where you practice, some well-meaning person speaks of the urban legend of the city zoo being an option. And no, not with cackling mean-person sarcasm but with a full-on, dead serious expression. A medical student looks stunned and queries whether or not a patient can truly go to the zoo for such a thing at which point whomever is speaking affirms it as the gospel. All of it reminds me of those stories of funny names in newborn nurseries, like the woman who named her twins "Oranjello" and "Lemonjello" since that's what they fed her in labor and delivery before she had them. Somehow the mother of those twins has managed to live in Cleveland, Ohio, Nashville, Tennessee, and Atlanta, Georgia. That, or she doesn't exist.
The zoo thing, though, I must admit always intrigued me. So, a few years after I came to Atlanta, I called Zoo Atlanta on behalf of a patient of mine. He needed a cardiac catheterization and I wanted to actually sniff out this trail to see if it truly would lead somewhere. Several of my calls were met with chuckles. Even when I reached some nice tech in the Large Animal area, he notified me that the zoo veterinarians did have X-ray machines and even a cath lab made special for elephants and such, but that actually having human cardiologists come in to use them on humans wasn't something he was aware they did. After that I spoke to our cardiologists who calmly answered me (while staring incredulously) telling me that logistically, it would be too much.
"We couldn't really do interventions either, Kim."
"Like place a stent or something?"
"Yes. And even if there was something significant enough for bypass, that wouldn't be an option either. The anesthesia risk would just be too great," the cardiologist said.
"I appreciate you actually thinking this through," I recall mumbling.
"This is really a sad, Catch 22 of a situation. I hate when it comes up."
And that was just sort of where we left that. But some piece of me has always felt this weird mixture of better because I actually checked before and discouraged for the very same reason.
Yeah.
So the truth is that, there wasn't anything I could do other than talk to her and listen to her story. And since she'd navigated the last several years of her life as what some would deem a "freak" I just made up my mind to humanize her the best I could.
I noticed her light brown eyes that almost appeared amber, framed with sprawling black eyelashes. She had a dimple in her chin that I thought was cute, whether she was smiling or not. The right cheek had a beauty mark on it, the kind that many women wished for but she'd obviously been blessed with at birth. And her teeth were unusually straight, large and strong appearing. Even though she didn't smile so much.
And so. I listened to her story of the transition from "always a chunky kid" to "overweight" to "really obese" to "freakish." I didn't rush her either. I just sat and paid attention and focused on her lovely eyes, her beauty mark and that cleft in her chin wondering what I could possibly do.
"Those surgeries scare me," she finally said.
"Surgery is a big deal," I replied.
"Yeah. I just feel like it would be such a failure to get an operation just because you couldn't stop eating."
I twisted my mouth and paused before speaking. "Food relationships are complicated. I think of weight loss surgery as an option that is now available that wasn't before, you know? But yeah, surgery isn't something to treat lightly."
"My relationship with food has never been healthy."
"I understand." I wondered if I should say the next thing in my head, but then decided not to overthink it. "I say just look into it. Make a decision after you look into it, you know?"
"Guess I'd not have much to lose, right?" After she said that we both chuckled at the unintended pun.
"Um. . .you could also look into . . . okay. . have you ever heard of this organization called 'Overeaters Anonymous?'" I inwardly cringed when saying the name of it but felt she should consider it. I hoped she wasn't offended. But she shook her head and looked intrigued.
I told her about this 12 step organization that tackled food relationships much like other tried and true organizations helped patients deal with substance abuse issues. And we looked at the website right then and there on our cell phones and she promised me she'd check it out.
And that was that.
We discharged her a few hours after that. Honestly, there wasn't really any more tests I could order and, fortunately, she was doing well enough where most weren't indicated anyway after all was said and done. But I have found myself thinking of her. Pondering her world and that threshold of going from overweight into, to use her words, "freakish." And usually it just leaves me feeling kind of sad.
That is, until this morning when I allowed myself to reflect on what I remember the most about her. Her smile, her enviously stunning eyes, that beauty mark that Marilyn Monroe had nothing on, the tiny indentation in her chin and especially her fearless transparency in describing her life. I realized that this is what I see in my mind when I think of her. And I see that part in greater clarity than anything else.
And that? That leaves me feeling hopeful that at some point something will happen that allows the entire world to see that, too.
Honestly? I write this blog to share the human aspects of medicine + teaching + work/life balance with others and myself -- and to honor the public hospital and her patients--but never at the expense of patient privacy or dignity.
Thanks for stopping by! :)
"One writes out of one thing only--one's own experience. Everything depends of how relentlessly one forces from this experience the last drop, sweet or bitter, it can possibly give."
~ James Baldwin (1924 - 1987)
"Do it for the story." ~ Antoinette Nguyen, MD, MPH
Details, names, time frames, etc. are always changed to protect anonymity. This may or may not be an amalgamation of true,quasi-true, or completely fictional events. But the lessons? They are always real and never, ever fictional. Got that?
