Stick together.

"I was next!"

"No you weren't!"

"Why are you cheating?"

"I'm not cheating!"

"You are!"

Their voices escalated from down the hall. I sunk my face into my hand and groaned. I wasn't in the mood.

"Mom!"  I took a big drag of air and tried to ignore it. It was repeated with more urgency. "MOM!

Next came a cacophony of clattering plastic. I'd attempted to sit at my kitchen table doing nothing enough times to know the exact sound of a PlayStation video hand control device falling to a hardwood floor. I squeezed my eyes tight and pressed my lips together.  Next came the feet stomping in my direction.

"Mom? Isaiah was supposed to --"

"No. No, he's exaggerating," Isaiah protested before his brother could finish his sentence.

I swung my head from side to side between them. Zachary was now blinking back mad tears and fuming. Isaiah held the plastic controller behind his back so that Zack couldn't reach it. They were at a stand still. And I hadn't even uttered a word of mediation.

And wasn't going to.

Clasping my hands in front of my face, I looked straight ahead into the space between them. "Listen," I said. "You will argue sometimes. You'll frustrate one another, too. But no matter what, I just need you to always remember what I say about brothers." Both boys stared at the floor, still fuming. I cleared my throat hard, "What do brothers do?"

The answer came as a mumble. They'd uttered that response so many times that me asking to have their words repeated had far more to do with me just wanting them to speak up than not hearing. I pressed them in a firm voice. "What do brothers do?"

"Stick together," they replied in low unison.

"Solve this. You solve it. And if you don't, nobody gets to play." I turned back to my computer and let them know I was done. Because I was.

Last week at Grady, I took care of a man with an advanced cancer. He was up in age. His parents had passed several years back. The ex-wife he'd had remotely was no longer in is life and they'd never had children. He'd had a few strokes that left him with labile cognitive function. And his health issues were significant and active enough to warrant somebody thinking about him and advocating for him.

Yeah. That's what he needed.

Again--there was no spouse. No common law boo wringing hands at the bedside in woeful misery. No parents filled with that unconditional parental love and no aunties or uncles who'd doted on him since he was a child. All there was was one person: His brother.

Now. This man's brother was a grown man with a full life. He had a wife and adult kids and grandkids, too. He had a business that he ran and a church where he deaconed and a square of lawn in front of both his house and his church that called for him to mow it on a weekly basis. But the other thing he had was a brother.

Sure did.

He'd come in with a work uniform on. Soiled with a full day's work and with this little hint of masculine mustiness that would waft into my nostrils whenever he moved. Sometimes he'd wipe his forehead with handkerchief or just the back of his hand. Or rub his eyes with the heels of his palm. But no matter what, you could count on him seeing about his brother.

Yep.

Brother was only the next-of-kin for my patient. And since some days my patient was with it but on most other days he wasn't, we needed someone to step in. We did. And let me tell you--Brother was there.

"I'm sorry to keep putting so much on you," I said to him the other day.

"It's okay. I just hate I can't get up here no sooner. My wife would've come for me but 'cept she got some hip troubles and ain't driving right now. So I can't get here 'til I get off."

"I understand."

"He look a little better to me today." Now he was dabbing that same hankie on his brother's brow.

"He always seems to perk up when you come in." I realized that may have sounded negative so I corrected myself. "He does look to be a little better."

We sat and talked some more. Brother asked hard questions and I answered to the best of my ability. We discussed next steps and what he thought would best honor his brother's wishes. This was a day that my patient wasn't flying on both wings mentally. That was happening more and more frequently.

Brother signed a few papers and placed the pen down in front of him. A big yawn escaped his lips, causing his body to let out a tiny shudder at the end.

"I can tell you're tired."

"It's okay. That's my brother."

I squinted my eyes at him and twisted my mouth. "I have sons."

"Yeah?"

"Yes, sir. Two of them. Sixteen months apart."

"They fight?" Brother laughed at his question. "I know they do. You always do when you close in age like that."

I laughed. "Pretty much."

"See, our mama always told us this: 'Take care of your family, take care of your mama and your daddy, and take care of each other. I don't care what you got going on. You stay connected to your peoples.' So I hear my mama straight in my ear sometimes. I be tired but I come on down here."

"I love that."

"I'm all he got."

I didn't know what to say do that so I said nothing. Then I finally said, "He's blessed."

"We both blessed."

We sat in silence for a few moments. Brother stood up and put his soiled trucker's hat back on his head. This time he addressed my patient. "Okay then, Junior. We'll see you tomorrow, okay?"

"Okay," my patient replied. Brother reached down to give him a tiny hug in the bed. Then he gave one more of those big yawns. He waved goodbye to me and before I knew it he was gone.

The whole way home I thought about them. I thought about a mother infusing this idea into her children of staying united. Letting no weapon formed against them as siblings prosper.

Ever.

That night over dinner, I shared with my boys about this story. With privacy protected, I explained that my sick patient had no one to look out for him in this whole world except his brother. And that his brother worked all day long and came anyway.

"I'd come for you." Zack looked at his brother. His face was serious.

"Me, too. I'd come for you, too."

And that was that.

I felt a tiny heave in my chest. Followed by a shiver like the one Brother had. Something about my boys saying those affirmations to one another had given me chills.

Yeah.

I've probably had to ask that same rhetorical question about what brothers do some fifty times since then. But after watching those two men fulfill that duty to one another, I knew that it was an important seed to keep on planting.

I'm learning day by day that connectedness requires intention. It involves forgiveness and redemption and resilience and commitment. And it especially calls for us to fight for the relationships we value the most.

The mama who raised those two men did something right. She made love and loyalty a rule. And no--sometimes it doesn't work. But what I do know is that the kind of sacrifice I witnessed between those two brothers didn't just happen overnight.

No it did not.

Do brothers fight? Sure. And will brothers get on one another's nerves? For sure. But as for me and my house? They will stick together--and stay connected. If I can help it, at least.

"I don't care what you got going on. You stay connected to your peoples." 

Damn right.

***
Happy Tuesday.

Get a grip.

What wisdom can sometimes look like.

I heard a talk given by one of the Grady senior faculty on something intriguing. He talked about "Wisdom in Medicine." Bill B., the one who gave this lecture, was the perfect dude to be giving this lecture for a few reasons. I mean, he is wise, yes. But he also has that whole wise persona about himself. White hair and beard. White coat that never, ever seems to have a speck of dirt on it. And all kinds of official letters behind his name after the M.D.

But I'm thinking that wisdom looks like a lot of things. Not just like Bill B. and Dumbledore.

Anywho. Bill B. talked and we listened and then we talked and he listened about wisdom in medicine.  He, too, suggested that wisdom can be found in many places and that we need to role model this for our learners. I was sitting at the end of the table next to one of my favorite Grady doctors, Robin K., who looked over at me and said, "Hey, do you feel wise sometimes?"

And the thing is, I laughed because secretly there are moments where I do. I looked at Robin and said, "You know? I don't know everything. But sometimes I do feel a little bit wise."  And we chuckled because honestly, who admits to being wise?

Just then, Bill B. shows a picture of Socrates and said that "Socrates was the only wise man of his time because he was the only one who didn't think he was wise."

Whoops.  My bad.

Maybe "wise" sounds a bit pompous and pretentious so that's why Socrates avoids claiming it.  Yeah, yeah. Fine, then. How about we refer to it as "mother wit" instead? Yeah. Mother wit.  Mother wit is that knowledge you get with time that can't be found in books. It's mostly learned from trials and errors and watching and sitting at the feet of elders. And Lord knows you don't need to be a doctor to have or gain that kind of wisdom.

This is why that discussion intrigued me so much. I like this idea of talking about the fact that being a good doctor or an effective human being is about more than pouring through articles and regurgitating big scary words and facts. It's about "getting it."  And how many times have all of us been in a situation where you see some aspect of a situation that some really smart-on-paper person just can't seem to get?

Now. Many a time that dunce has been me. Picking through every single fine detail and sifting through medical literature to find an answer when what I really needed was just some mother wit.

Which reminds me.

There was once this man I was caring for who I'll call Mr. Everett. He'd had a stroke and a prolonged hospitalization. Mr. Everett had to learn how to do the most basic things all over again, and lucky for him and us, he was super motivated to do just that. He worked with PT to walk again. He worked with OT (occupational therapy) to lift a fork and comb his hair again, too.  There was only one problem that kept making things difficult. His blood sugar control.

Technically, it wasn't that problem per se. The thing is that Mr. Everett was having issues with eating and chewing after his stroke, which greatly affected his caloric intake. With wacky food intake, the insulin he received for his diabetes was all over the place. Talk about frustrating. He was hell bent on not having any kind of feeding tube placed, yet no matter how many times we tried to advance his diet, he'd gag and sputter and have issues.  He'd passed the swallowing studies and the speech/chew folks assured us that his mechanical ability to eat wasn't the problem. Which kind of sucked considering he'd come so far with regards to everything else.

So on and on it went. Liquids ----> thickened liquids ----> soft mechanical diet ------> regular diet -----> gagging, sputtering, not eating----> thickened liquids --->soft mechanical diet -----> regular -------> gagging, sputtering, not eating. . . .

Uggh.

"Mr. Everett, I'm not sure we can pull off having you eat this regular diet. Even with help, you have trouble," I'd say.

"I don't want no feeding tubes feeding me. I can eat and I want to eat."

That's all he would say. So this went on for easily more than seven days.

Then, one day I come in and see Mr. Everett sitting up in the bed throwing down on his tray. Cutting, slicing, peppering, grubbing. I was totally perplexed, as was his nurse.

"Mr. Everett!" I exclaimed, "You're eating! And swallowing! I'm so happy!"

His nurse had similar things to say and we were so happy that we did the cabbage patch dance around his bed. He simply smiled, swallowed and dug in more.

What the?

And so a few hours later, I'm rounding with the team and gushing about Mr. Everett's esophageal epiphany. I went on and on about him feasting on the breakfast tray and even demonstrated the dance that I did with the nurse.

"I guess it just all finally came together!" the senior resident said with a triumphant smile. "He must have just needed some time."

"Yep. Time seemed to be the key," I responded, "but it's really kind of amazing how all-of-a-sudden it was, you know? Like someone unraveled a mystery."

And we all sat there over tepid coffee, smiling at feeling all proud of ourselves for "curing" Mr. Everett. Now his blood sugars were consistent and he was on his way to getting discharged.  Score.

Then, in comes one of the interns, Nicki M., who'd been off dealing with another patient. Her co-intern looks up and says, "We were just talking about Mr. Everett. Can you believe it? He's eating! Like a champ! Dr. Manning said he cleaned his plate this morning--a regular diet, too!"

We were all so invested in him as a team that, even though Nicki wasn't the primary intern caring for him, this good news was for her, too. Nicki scooted her chair up to the table and nodded. "I'm so glad that worked for him."

I was puzzled by that statement. But his improvement was awfully abrupt, so I couldn't resist getting clarification. "What? What do you mean 'that worked?'"

Nicki rocked on the back legs of the chair and answered with nonchalant shrug, "Poligrip. Extrastrength."

We all looked at each other in disbelief.

Yes. You read that right.  Poligrip. Extrastrength.  

It turns out that Nicki had heard about Mr. Everett so much on rounds that she'd decided to go hang out with him in the middle of the night during her call night. She looked and listened and asked and explored. And you know what she discovered? That at home he uses extrastrength Poligrip for his dentures and that the kind he's been given in the hospital both irritates his gums and doesn't work. Every time he tried to macerate his food, he couldn't. Because his dentures were too loose.


Seriously?

So Nicki called the pharmacy and they didn't have it. The next day, she personally went to CVS and bought him some. Simple as that.

Now. You tell me--was that mother wit or what? Something had told Nicki to go in there that night. It wasn't even her patient, but she went. Something made her think beyond all the technicalities and academic things to something as simple as denture adhesive.  Denture adhesive.

So, yeah. I've had a few of those Poligrip extrastrength moments in my life. And fine. If Socrates doesn't want me to refer to it as wise--I won't. But I think Bill B. was right.  Medicine and life are about a whole lot more than just being smart.  You need the knowledge, yes. But most of all you need you some "mother wit" and an ability to just "get it."