Reflection from a Tuesday: Giving Your All and Getting Your All

"You cannot have it all."

That's what this senior female faculty physician said to my colleague-friend, Tracey H., amidst the beeping IV pumps and background hustle bustle of the ICU one day. Tracey was a new medical faculty member at her institution struggling with what many of us struggle with: figuring out how to effectively love on your husband and seamlessly raise up your children all while simultaneously saving the world as a clinician-educator/clinician-investigator/clinician-leader. Oh, and figuring out how to do these things while being happy at the same time.

So that was the advice. It wasn't, "Girl, you can do this" or "Chile, you can do that." It was this simple truth, as mundane as it was cutting edge. "You cannot have it all."

That was the first time I'd heard someone say this. The second and only other time I heard these words hit me even harder than the first. I'd slipped into one of these "Women in Medicine" panel discussions at the ACP National Meeting a few years back, and this really wise looking woman grabbed the microphone sitting in front of her with her right hand to make sure we heard her clearly. A room full of earnest, young, early career female clinical faculty members sat with baited breath. We'd already heard that we needed to speak up for ourselves. That we should not be afraid to take on big tasks with the big boys. And to not fear a confrontation, but to always lace all interactions tightly with insurmountable poise and professionalism. This is how we'd get where they were. Chairpersons of Departments, Deans of Medical Schools, nationally recognized researchers and educators, well-respected Division Directors, and all-around bad-asses.

That's when this Jedi Master perched her scarlet reading glasses on the tip of her nose and tucked her graying hair behind her ears, cleared her throat and said,

"My advice? Work hard, and learn to be an effective leader. If you do that you can achieve anything. But know this: It comes at a cost. You cannot have it all. You cannot be on the vertical quest for Department Chair and make all of the soccer games at the same time. Something has to give. So, my advice? Decide what you want. And always know that the pinnacles of success in medicine comes at a personal cost--especially for women--so never trick yourself into thinking otherwise. Trust me, I know. You cannot have it all."

Wow. Everything I heard after that sounded like garbled background noise. I'd never seen or heard a woman care so little about saying what was popular as this senior faculty member. She broke it all the way down. Perhaps I felt so convicted by her statement because, like my friend Tracey H., I was juggling life with a husband and two small children with climbing up the clinician educator ladder. I'd often ask myself, "How can I possibly publish 4 papers per year, and teach, and write a book chapter without interrupting my family life? How? How can I reach my full potential professionally without feeling like a failure in my personal life, or vice versa?"

I'd never known even part of the answer until that day. This was the start of me achieving a new level of comfort in my personal and professional lives, all from five simple words.

"You cannot have it all."

Genius. Well, the truth is that many of the women there did not find it so genius. They made passive aggressive comments that negated what, in my opinion, had been the most profound thing I'd heard in a long time. They didn't like that word 'cannot.' But, me? I thought it was genius. Or as my friend, Tracey H., said about the woman who said the same thing to her that day in the ICU, "It was more than genius. It was dope." Yeah, dope.

They had these microphone stands in the aisles for people to get up and ask questions or make comments to the panelists. I think the majority of the women there had written off my new guru, directing all of their words to others on the panel. The ones who rah-rah-rahed and sis-boom-bahed them into believing that 36 hours could be jammed into 24, and that, forget what that eccentric old party-pooper said, you can so have it all. But me? I wasn't buying it. I stood squarely at the end of that line, inching my way up to the microphone to get more clarity on the gospel that had indeed reached me, if no one else.

"Hi. My name is Kimberly Manning and I'm an Assistant Professor in Atlanta, Georgia. My question is for Dr. (I still can't recall her name.)" She leaned into the mike again, her red readers still at the tip of her nose. "I was hoping you could give me more clarity on what you said. You said, 'You cannot have it all.' Does that mean not strive as hard? Say 'no' more often?"

She smiled and pulled the microphone down again. "Dr. Manning, thank you for your question," she started, "No. You should strive. But here's the thing: you have to redefine what it means to be successful. That is a very personal definition. For me, it is helping decorate my son's dorm room at Yale. Another time it's sitting here on this panel answering your question. Dr. Manning, the minute I realized that I could not have it all was the moment discovered that I'd had it all from the start."

"So in other words, you can have it all," I said, taking in every drop of her sage advice. I watched her carefully; I didn't want to miss a thing.

She raised one eyebrow and leaned her face into her propped up index finger. With a half-smile she continued, "You can have your all. Just not yours and everyone else's at the same time. Your all and someone else's all may be completely different. You got me?" I SO got you, Jedi Master.

This turned out to be one of the most memorable "Karate Kid/Mr. Miyagi moments" that I've ever had in my career. I felt like an enormous weight was lifted off of my shoulders. "I can have my all," I whispered to myself. "Just not everyone else's at the same time."

Me and kids enjoying the sunset on the Potomac, Independence Day 2010

Today I am reflecting on what it means to have it all. Or better yet, what it means to have my all, and how I define success. My definition includes a deep and meaningful relationship with my husband, time to be physically and emotionally present to my children, family and friends, and professional growth that pushes me to my personal best but doesn't impinge upon the former two. This is my all. And now that I know what it is, I know that I can have it all indeed.

Glimpses of my all:

With Isaiah at the Georgia Aquarium 2008

Isaiah, Christmas holidays 2009

Me and Zachary on the way to the Pentagon

Daddy and Harry with the boys, June 2010

Mommy with the boys, Mother's Day 2009

Harry and me, wedding anniversary May 1, 2010

Mommy and Zachy making Arthur character cookies
with my best friend, Lisa, May 2010 (expecting her first baby, yay!)

with nearly all of my student advisees (potluck at my place 2009)
little sis/bff, Darlene, at Farmer's Market in L.A.

Do you think a person can have it all?
What is your all?

The Internship and Residency Chronicles Volume I: The AMO and Shady Femurs

Based upon sho'nuf and true events. . names, details, etc. changed. . . .

"Please no."

Beep beep. . . .beep beep. . . .beep beeeeep. . . .

I wish there was a way to describe the sound of this pager that we were asked to carry when taking call as the AMO, or admitting medical officer during my residency. This was one of the most heinous calls we took as upper level residents. One pager number -- 1181 (I still remember it)--sealed your doom for the night. That pager was tossed from one resident to another like some horrible, searing, hot potato. The start of a long night on call was always signaled by clipping the AMO pager onto your waist, which, when placed next to your own personal pager, gave you the "double pager sign"--an outward way to tell the world that you are kind of a big deal.


The conversation would go something like this:


"You going with us to the Indians game tonight?"

"Nope, on call, can't go."

"Bummer. What service you covering?"

"I'm the AMO."
(Friend wincing) "Ooooooohhhh. . .the AMO-Whammo. . .ouch. Did you at least get a good night's rest yesterday."

"Not really, dude. Was carrying the clinic pager so got called all night."

"Wow, man, sucks to be you."

"Yeah, thanks."



The AMO had the great fortune of being paged for every single medical admission to the hospital between 5pm and 8am--regardless of acuity--and then triaging them to the appropriate floor. The AMO was also responsible for running all codes on the Medicine service, seeing all medical consults from non-medical services (like surgery or psychiatry) overnight, assisting with all needle sticks and exposures (random, I know!), and even backing up any resident or intern covering a floor who couldn't seem to pull their weight. The AMO was the destination for advice calls, hospital transfers, and the default for nurses that didn't know who else to call--especially if they knew you.

"Hey, Kim. This is Alice in the CCU. I think one of the techs has pink-eye. I saw it was you on call and thought I'd call you to come and check it out. . . . ."

No kidding--once someone paged me to ask directions to Jacob's Field for an Indian's game. That pager was like 411, 911, and 0 all rolled into one tiny black box. And that heinous little black box! It went off all. night. long. What made it worse was that some kind of wire was loose in it, so instead of beeping, it sort of bleated. A slow, nauseating bleat in an escalating, nasal, milquetoast pitch. . . . Ugghh. I feel sick just thinking about it right now; the same Pavlovian response I had back then.

The AMO call night from hell

It was a cloudless spring night in Cleveland, Ohio. The kind of weather that made being in the hospital overnight just that much worse. The hospital was busy and full. . . .but not full enough to be closed to new admissions (which was music to an AMO's ears.) This particular night, the patients were sick. Not just sick . . . .but sick-sick. The bleating pager was unrelenting.

I remember getting the calls, seeing the admissions as quickly as I could, and then calling the resident covering the floor to which the patient would be triaged. I'd already seen over twenty patients that evening; I knew this because for every patient I saw, I stuck their identification sticker on the right leg of my scrub pants. By 2:30 am, my right leg was covered with labels. Twenty-six to be exact. I'd already run two codes, dealt with a needle stick, and helped the residents covering the ICU place and arterial line. Twenty whole minutes went by without the bleating pager making a peep. Could it be? A moment to sleep. . .perchance to dream?

I made it to the 9th floor and finally into the call room. I kicked off my clogs, dived onto the scratchy sheets, and, just before closing my eyes, yanked my pagers off of my waist and placed them onto the dreadful hospital issue pillow right beside my head. (Every good resident knows the danger of sleeping through pages when you're exhausted.) Within two seconds, I'd fallen asleep. The time stamp on my pager read 2:50. Zzzzzzzzz. . . . .

Beep beep. . . .beep beep. . . .beep beeeeep. . . .
"Please no," I said aloud to God or anyone else who might be listening. My eyes flew open and looked at the ceiling, which had some kind of disgusting water stain on it. The impatient pager began bleating again. I repeated, "Please no." I was so tired I could vomit. Have you ever felt that way? So tired you could vomit? If you haven't, I hope you never do. This is exactly why folks always advised against trying to sleep on busy call nights. The only thing worse than no sleep was this: the sleep tease. It was now 2:57 am. This absolutely qualified as a sleep tease.

I looked at the pager and. . . .whew. . . . breathed a sigh of relief. It was a number I recognized, and most important, it wasn't one from the Emergency Department. Even better, the number was followed by an asterisk with four more numbers--our way of adding our pager number or "signature" to let the person being paged know who was calling. At the very worse, it was a sick patient. At best, it was a someone asking a clinical question. I rolled over and dialed back the number.

"Hey, Kim . . this is Mark, the intern on 9B."

"Hey Mark," I replied trying to sound as chipper and welcoming as possible despite the lingering nausea I felt from the sound of the pager. "Is everything okay?"

He let out a nervous laugh. "Umm. . . . well, yes and no." Mark was an excellent intern. He was mature, organized, responsible and a great independent worker. I knew I could trust whatever he said, and could count on him to follow through with my directions. "Ummmm. . . .so, I've gotten 5 admissions tonight, and they're all fine. . . .but. . .uhhh. . .I, like, haven't seen my resident. . . . .since. . .I don't know. . .like 9:30?"

I bolted upright in the bed. "What? That makes no sense. I've called all of the admissions to Nick directly. How have you even known about them?"

"Well, that's what's weird. He's called me with the admissions and that's it. I haven't seen him otherwise."

"Whaaat?" I asked again. This was crazy. The drill was simple. I get the admission. I go see the admission. I decide if the admission should go to the floor, the ICU or telemetry. I call the resident covering the floor. The resident calls the intern and they go see the patient. The intern writes the orders, and both the intern and resident write admit notes. Simple enough. "Who's seen the patients with you?"

"I kept thinking he was going to come, but he hasn't. It's really odd," he replied, "I did take an EKG to him to look at in the call room. I mean, I'm really comfortable with each patient, but I've managed them on my own."

"What the. . . .?" I muttered under my breath, deciding against the expletive. "Give me a couple of seconds. I'm coming over there to help you." I slammed down the phone and jammed my feet into my clogs. I was so tired. Too tired for some drama, which is exactly what this sounded like. I picked up the phone and paged Nick. Two seconds later, I was startled to hear his pager go off in the call room right next to my own. The dude was in the call room right beside me. Despite realizing this, I still leaped when I heard the phone jingling on the nightstand right beside me. Well, at least he was answering pages.

"Uhhh. . . .Nick?" I answered.

"Hey Kim, what's up?" Okay, I could hear him through the receiver and the wall. Sounding all energetic and wide awake. I smacked my palm over my face and shook my head. This was the "what's up" of a person that had nothing unusual going on. Before I could even say anything, he said, "Got a patient for us?"

Us? Was he kidding? I was too tired for this. I had no idea what to do, so I said, "Hold on for a minute." I lay down the receiver and looked at my leg full of patient labels. I smacked my hand over my face again, and began patting my foot to release the mounting anger. Here's the problem: Nick was covering not only Mark, but also Jeannie on another floor. She'd been given four admissions in addition to Mark's five. If this dude has not seen any of these nine patients, I am going to have to kick his ass, I thought. (I wish I could say this violent thought did not cross my mind, but it so did.) I marched out of my tiny room, walked next door and banged on Nick's call room door. Hard.

Either he was slow or hard of hearing. Nick opened the door like he was expecting to see housekeeping with new towels. He jumped back when he saw me. "Oh, hey Kim!" he said wiping the sleep from his eyes. His thinning hair was standing all over, screaming "bedhead." You have got to be kidding me.

I scanned the room. TV was on. VCR player in the room with VHS tapes FROM BLOCK-fricking-BUSTER sitting on the nightstand. An empty diet Coke can and half of an eaten stromboli lying in an open box. A honey bun wrapper, a crumpled bag of microwave popcorn and some coffee that appeared to be from hours earlier. It looked like a hotel room with excellent room service. In other words, this dude had been CHILLING. Do you hear me? Chilling! All. Night. Long. I placed my hand firmly on my right thigh, to keep me from, literally, kicking his ass right then and there.

I wasted no time being passive aggressive. I jumped straight to it. "Nick, Mark said you haven't seen any of his patients. What's going on, man?"

"Oh, I knew I hit paydirt tonight. Mark and Jeannie are strong. Those guys are on auto-pilot man. I told them to call me with questions, so as you can see, they didn't need me!" He gestured to the rockstar suite behind him. Was he serious? At this point I crossed my left leg over the right, as surely he was about to catch an Inglewood style beatdown in the call room threshold.

"Are you serious or are you joking? Have you not seen the NINE patients I've called to you? What the hell is wrong with you?!"

"It's May. They are almost residents," Nick replied with a shrug.

"But they AREN'T residents," I shot back unable to hide my anger. "Dude! You're supposed to see the patients and review their orders and also write your accept note -- you know that! What the hell, Nick?" I couldn't believe this. Sure, everyone knows that some residents and doctors can be a little bit shady. But this was so egregious. . . hands down, the shadiest, laziest thing I'd ever seen. I was so tired and I knew what this was about to mean. It meant I would be seeing and reviewing all of the orders and writing all of the notes. (Back then, residents wrote an accept note or mini-history and physical to accompany the intern's note.) This would have me working at a breakneck pace until morning report. I was so, so tired. I wanted to throw up. On him.

"You're overreacting," he retorted nonchalantly, "Bet you didn't know that the attending bills from the intern note, not ours. We don't even need to write a note technically." He smiled all wide with his big yellow teeth.

"I should kick your ass, Nick," I growled. (This was before we taught about the importance of professional peer interactions, too.)

I couldn't take it anymore. If I didn't get away from him, I'd be arrested for assault and battery of a lazy classmate. The can of WUP-ASS was not only opened, but ready to be served. I spun on my heel and left without another word.


I walked briskly from hall to hall like one of those mall powerwalkers. For the rest of the night, I did Nick's job and mine. I answered random pages and reviewed orders, plans and findings with interns. I did not sit down for more than 5 minutes for the rest of the night. It sucked.

The following day was Thursday--my clinic day. As a combined Internal Medicine/Pediatrics resident, every Thursday afternoon from 1 -5pm, I alternated between my Internal Medicine clinic and my Pediatrics clinic. Whether I was on call, post call, no call, or any other state you could think of. Any chance of leaving the hospital early was out of the window. Despite my night from hell, this was just the way it was before duty hours reform. This sucked, too.

Post Call Clinic--going on 34 hours straight of working:

At about 3:45p.m.,I was sitting across from my attending telling her about one of my patients that I'd just seen in clinic. All of a sudden, I felt someone shaking my shoulder and heard my name.

"Kim! Kim!!"

I jerked awake and immediately realized that my mouth had been wide open. Hanging from my glistening lower lip was long piece of drool that had collected into an unattractively large puddle on the desk and all the paperwork in front of me. The pen in my hand had captured writing that gone from sloppy, to tiny and not discernible, to one flat, diagonal line across the encounter form. Nice.

"Go home," my attending spoke with a mix of concern and disgust. "In fact, go to a call room until you can get someone to give you a ride home." It was one of the kindest yet simultaneously mortifying moments I'd experienced in my entire 4 years of training.


I can't promise you that I went to a call room to sleep. If I recall correctly, I had two shots of espresso, rolled down the car windows and smacked myself in the face repeatedly while reciting "Rapper's Delight" all the way home.

Two days later, I was AMO again. Great.

***

So the good news is that this horrid work-fest would never happen now under the current resident duty hours regulations. And to that I say, "Hallelujah." Drooling all over a desk when you're old enough to vote is not good.

Okay, so I bet you're wondering what happened to Nick. Well, I told the chief residents, who thanked me for stepping in. I also told my residency friend and confidant Tracey H., who said what became one of our most classic exchanges ever:

Tracey: "I could've told you that dude had a shady bone in his body!"

Me: "Not just any bone, but a big bone, man. This was not like a shady metatarsal. . .this dude had like. . . . a shady femur."

(Nerdy, I know. But still something that makes Tracey and I laugh until we feel sick.)

I suppose somebody scolded that guy Nick at some point, but in the end, he smiled and received his residency diploma right along with the rest of us. Now he's probably somewhere doing who knows what. . . . .

I knew I should've kicked his ass when I had the chance.

The Internship and Residency Chronicles: Sleep is for Wimps?

I started my internship on June 23, 1996. Before the 2002 ACGME hammer came down on residency programs, mandating them to start clocking duty hours and giving off-days. A lot has changed. Today, by graduate medical education law, resident physicians can't work more than 80 hours in one week, they can't work more than 30 hours straight, and they must get at least one day off from clinical duty per every seven. As a matter of fact, as of last month, there are even tighter regulations including new rules that prohibit interns from being on duty longer than 16 hours. Boy, it ain't like it used to be.

For the most part, I think these changes are good. For example, falling asleep at every stop sign on the way home from work is not good, and working twenty four 12-hour ER shifts in a 30-day month--oh yeah, and did I mention the half-days of mandatory clinic on four of your six off-days to boot? Yeah, so to those days, I say good riddance. But just to keep the nostalgia of the ol' baptism by fire days warm and toasty, I decided to include some posts inspired by my life during residency. Stay tuned for some good times. . . . .

Reflection on a Friday: Say What?

(*names, details, etc. changed. . .you know what's up)

(A big-a, red-a sock)

______________________________________________________________
"Why don't you say what you say when you say what you said anymore?"

- from Jermaine Jackson's "Do What You Do"
_______________________________________________________

I often wonder what's the best approach to teaching about patients at the bedside on rounds--in front of the actual patient. I struggle with vacillating between medical language and living room language, feeling like I'm some bilingual person that is neglecting to fully interpret everything to the monolingual bystander. Because of this, I try to pay attention to how I talk to patients, and also about them. And usually, I will offer a disclaimer before I speak in our "other language."

It turns out that some of the terms used in every day English mean something different in Med-lish. And, like I said, usually I'll remember that when I'm talking. . . .that is until I run across an unexpectedly exciting medical encounter. Here's an experience I had where all my medical manners went out the door (all secondary to my clinician-educator nerdiness.)

_________________________________________________________
This one time, on the Grady wards. . . .

"Hmmm. . . . impressive," I said on rounds one day while looking at our patient's leg with my team. "Really impressive." The interns, student and resident gazed at the limb-in-question, doing their very best to take mental note of what qualifies as "impressive" by an attending. I quickly turned my attention to Mr. Banks, our patient, who was anxiously following our discussion. I offered him an easy smile which seemed to relax him a bit. "Sir, we're just shop-talking for a few moments. We promise to explain everything we're saying to you in a few moments, okay?" He nodded, but still watched us intently.

"He said that this started two days ago as a little bit of erythema, but then it just evolved into this confluent, angry eruption," spoke the senior resident."The good news is that his blood cultures are negative and his temperature has already come down nicely with this antibiotic regimen."

I followed the redness down his calf to the top of his foot. It looked like a shiny, red boot made of skin. "Wow, this is angry." I reached down and touched his skin gently with my gloved hand. He winced and I stopped abruptly. "Sorry, sir," I apologized. He nodded again and smiled bravely. "Mr. Banks, has anything like this ever happened to you before?"

"Naw, not really. I mean this one time, I had the cellulite on my foot after a sore got infected, but they didn't even keep me in the hospital for that. I just took some pills and it got better. This time? Shoot, it's waaay worse."

"Hmmm," I murmured while still studying his leg. Now that it was clear that he was clinically responding, I allowed my inner clinician-educator-nerd to be unleashed. OMG, erysipelas! I haven't seen or talked about erysipelas in forever! Cool, man. This is a really cool case. I could feel myself getting ready to foam at the mouth from excitement about this upcoming teachable moment.

Why, you ask? It's what nerdy clinician-educators do. I mean. . . .imagine running across your most favorite episode of Good Times or What's Happenin' that you haven't seen in like, forever and ever, but that you loved and remembered every punchline to. (Whoops--just realized that not everyone reading this is an African-American raised in the 70's. . .uh. .my bad. . . so. . .make that, errr. . .Buffy the Vampire Slayer. . .errr. . . .or Dawson's Creek, maybe? Look, you get the picture.)

"Mr. Banks, sir?" I queried. Mr. Banks looked up at me with raised eyebrows. "I'm going to chat with the team a bit, okay?"

"That's cool, Miss Manning," he answered while reaching for his cell phone amidst the heap of sheets on his hospital bed. I redirected my attention to the medical student standing next to me. This is so cool, I thought. Hmm. . .how will I even begin?

"Ronald, what is St. Anthony's fire?"

He looked startled, and then cocked his head and pursed his lips. "Beg pardon?"

I smiled and cleared my throat. "St. Anthony's fire," I repeated. "Have you ever heard of St. Anthony's fire?" The interns looked at each other nervously, knowing how predictably such Socratic questioning moves up the food chain. They both immediately stared at the floor when Ronald shook his head no. "Phone a friend, Ronald. Who's your consult?"

"Errr," he glanced at the two interns quickly, "errr. . . .Sharon." He shrugged his shoulders and offered her an apologetic grin. I moved the spotlight to Sharon, one of the interns.

"Is it, like, some kind of . . . .uh. . . . medical thing?" she stammered.

"Yes. It actually is a term used to describe two different things, but since we're in the United States, I'm referring to only one of them. Do you know what condition is referred to as 'St. Anthony's Fire?'"

Foster, the other intern, piped in before he could get placed on the hot seat. "Is it used to describe cellulitis?"

I delicately pulled the cover back from Mr. Banks' leg to fully expose the skin above the knee, using care to respect his privacy. "Look how angry this skin is," I pointed out. "Now notice how the skin is intensely red and raised but then how right here all the angry area abruptly stops. This sharp border here is called a leading edge. Mr. Banks has more than just a cellulitis." The team nodded intently.

"I coulda told you that!"remarked Mr. Banks. "When I had the cellulite, it was red, yes, but naw, it didn't have nothin' on this here."

"Right, Mr. Banks," I acknowledged, "You are absolutely right, sir." Everyone looked at Jenny, my senior resident. She was last on the food chain. "Okay then, boss, what would you call this?" I offered her a half-smile.

She squinted her eyes and took an exaggerated breath. "Erysipelas, Dr. M? I've only read about it, but would you call this erysipelas?" (I love it when learners answer my questions with questions.) I gave her a congratulatory nod. "St. Anthony's Fire?" she added. "I don't know that part, though." In other words, Don't even go there, Manning.

(Erysipelas, courtesy of ADAM online health photos)

"Yep. That's what they used to call erysipelas back in the day. St. Anthony spent most of his life in the desert, and honestly, that's about as much as I know about him," I told them. "In some countries, they call ergotism, or any overdose on ergot derived medications, St. Anthony's fire. Here in the states, if you hear that term, it's most likely erysipelas." No one said anything so I went on, still enjoying every second of the subject. "Erysipelas is almost always caused by invasive streptococci. What really distinguishes it is the extreme confluent erythema and induration with blistering, see? And that classic leading edge. Folks used to draw cultures by aspirating a bit of fluid into a saline-filled syringe right from the leading edge." I still had a captive audience. Now I was in my rabid teach mode; a very dangerous zone for lazy learners, which fortunately, this team did not have. "In the pre-antibiotic era, this was a tremendously feared and deadly infection--especially in babies."

"Babies?" gasped Sharon.

"Yep, babies." I continued. "The majority of cases used to be on the face, but the extremities, especially the legs are also well described affected areas. Some of the worse cases you can see are on the face."

"Damn!" exclaimed Mr. Banks causing all of us to startle. "I'm glad this ain't on my face!" We all collectively smiled, wholeheartedly agreeing with our patient. He seemed to like the attention. "Miss Manning, I learned a whole lot just now. When my old lady come up here, I'm gonna tell her I got the St. Elmo's Fire!" This time I couldn't help but laugh out loud.

I reached for the clear bag of antibiotics hanging from his IV pole, turned it over, and read the label. "Mr. Banks, this medicine is already attacking the germ that's causing this problem. I'm hoping this will get a lot better while you're here."

The resident explained the rest of our plan to Mr. Banks and we prepared to continue our rounds. This is good medicine, I thought feeling proud of our interaction with Mr. Banks. Our team is practicing good medicine. I punctuated the encounter with my standard question of all patients every morning, "What questions do you have for us, sir?"

Mr. Banks winced and gingerly place his leg on top of a pillow. Then, he snapped his finger and said, "You know what? I do got some questions, doc." I raised my eyebrows in anticipation. "First, why you first said my leg was 'impressive? really impressive?' Then what is 'confluent ery-deema?' Y'all said that twice. Oh, yeah, and why you kept calling my leg 'angry?'" The whole team laughed. But Mr. Banks didn't.

I felt my face growing a little hot with embarrassment. I couldn't believe I'd done that. The residents all know how much I emphasize avoiding too much medical jargon at the bedside of patients. How could I have gotten so caught up in this "cool case" that I'd forgotten to follow my own ground rule: "Listen to yourself and your team speak, and autocorrect as you go." Uggh!

"Um, Mr. Banks? Uhh. . .I think I owe you an apology." The team looked intrigued. "Sir, I haven't seen any one with. . .well 'The St. Anthony's Fire' in quite some time. I got so wrapped up in talking about you that I forgot about how I was talking to you and about you." I let out a sigh and started to answer his questions. "First, I shouldn't have said 'impressive.' It was really me saying that I hadn't seen skin this. . . .well. . . .angry in a while. When I say angry, I'm talking about how red and warm your skin is. . . ."

"Kinda like how somebody look right before they 'bout to kick somebody's ass?" laughed Mr. Banks amusing himself with the metaphor. I was glad he was being a good sport.

"Yes, sir," I replied while pointing my index finger at him for emphasis, "Exactly like that. And the 'confluent erythema' is just a term we use to describe when. . . all the red, angry parts start running together."

"Like a big-ass, red-ass, hot-ass sock on my leg, huh, Miss Manning?" We all laughed again. This time, Mr. Banks laughed, too.

Lesson learned from Mr. Banks:

Sometimes the patients are better interpreters of our medical language than we are.

Reflections on a Tuesday: Jeremiah's Eyes

*names, details, etc. changed. . . . .

Butterflies begin from having been another
As a child is born from being in a mother's womb
But how many times have you wished you were some other?
Someone than who you are?
Yet who's to say if all were uncovered
You would like what you see?
You can only be you
As I can only be me.

from Stevie Wonder's "I can only be me."

____________________________________________________________
"Jeremiah"

I had just heard him presented to me by one of the interns on our team. A young man. . .not even legal yet. . . admitted with community-acquired pneumonia. "Double pneumonia" as some patients refer to it--the kind of aggressive lung infection that doesn't limit itself to only one lung or even one lobe. I stood tall, with my arms folded as the story unfolded before me.

"His white count is low," spoke the resident as the team stood in a semi-circle around the chart box, "like only two thousand." I nodded and continued to listen.

"If you calculate how many of those are lymphocytes, it's like not even fifty," added the intern.

"Do we know his HIV status?" I queried, considering one of the most likely causes of such a reduced white blood cell count. The team cast glances at one another, as if saying, I knew she was going to ask us this.

"He refused to be tested. . . and also denied every possible risk factor," the resident responded with an exaggerated sigh. "No matter what I asked, it was, 'Nope. Nope. Nope.' That's pretty much how the entire history went."

We wrapped up our discussion and entered his room to get more insight. I made confident, deliberate strides as the leader of my team; always believing that self-assured doctors make reassured patients. After passing by the first bed and pulling back the curtain, I froze. There sat a slender, young African-American man who could have easily passed for a pre-teen. I scanned his patient information. 20 years old. But it wasn't his youthful appearance that struck me the most. . .it was his troubled and lonely eyes.

He was, literally, shaking when we approached the bedside. . .vibrating beneath the she sheets. I did my best to relax him."Good morning, Mr. Foster. . . ." I smiled wide and cupped his hand in both of mine, "I'm Dr. Manning, the senior doctor on this team."

"Hi, Dr. Manning," he replied in a delicate and undeniably effeminate voice, "I'm Jeremiah. Call me, Jeremiah, okay?"

"Jeremiah," I repeated with a nod for emphasis. "What a strong name--Jeremiah. Okay. . .then Jeremiah, it is." He seemed to relax just a little bit which nudged me to continue. "Jeremiah, I heard a lot about you from my team. If you don't mind, I'm just going to recap what brought you into the hospital to be sure I have the story right. Is that okay?" He nodded quickly.

And so I narrated back to Jeremiah exactly what I'd been told. That he had been fine until two days ago when he started having shaking chills and coughing up something that looked like rust or blood maybe? That he'd never been sick before this. And that he'd never been hospitalized. Ever. Other than this pneumonia, he had never had any medical problems. He filled in the blanks with more information. Like the fact that he lived with his mother, and attended community college where he was studying to maybe be a nurse one day. That he sang solo in his church, and played a mean piano. Never smoked anything in his life, once tried alcohol and hated it, oh--and hadn't yet had his sexual debut. Ever. "Not even close," he said emphatically. His body was shaking again.

I listened as the intern explained to Jeremiah that he was being treated for a fairly extensive pneumonia. He was improving with our treatment, but his low white blood cell count was concerning. That sometimes people who have HIV can get really bad pneumonia. Had he ever been tested for HIV? Would he reconsider getting tested? Is he sure there are no risk factors we may have overlooked?

Nope. Nope. Nope.

We asked Jeremiah if he had any questions, and eventually left his room without much more insight or information on this man with the childlike face and the lonely eyes.



Later on that evening, I was standing at the nurses station writing a note just before heading out to pick up my kids. "Dr. Manning?" I looked over my shoulder and found Jeremiah timidly standing in the doorway. His narrow shoulders were wrapped in a hospital sheet, and his eyes were still sad and troubled. I took in his searching expression. The clock directly above my head had just creeped beyond the 5 o' clock mark.

"Hi, Jeremiah." I wanted him to hear me say his name, to know that he was worth remembering.

"Can I. . .do you have a minute to talk to me?" His voice was shrinking and now his body was trembling again. But I needed to go. Being late to daycare sets you back $1 per minute. But his eyes said, I need you. Those troubled, lonely, tired eyes. They needed me. I couldn't leave.

"Of course," I said while walking over to him. Crossing the threshold into his room, I dragged a chair over to his bedside and we both winced as it screeched across the floor. I mouthed the word 'sorry' and leaned onto my crossed legs with my elbows. Jeremiah settled back into the bed.

"Did you see I'm off oxygen, Dr. Manning?" He sounded nervous. Like this wasn't what he wanted to talk to me about. It wasn't what I wanted to talk about either. I took a deep breath and willed myself to be patient.

"That's really good. It's a huge step towards you getting out of the hospital."

"Oh okay. . ." His voice trailed off. I could feel myself getting anxious. $1 per minute for every minute after 6 p.m. The clock now read 5:14 p.m. . . . But his eyes. They are willing me to stay put. To wait. To listen. I swallowed hard and waited. He remained silent. But those eyes. . . .for some reason they seemed to be waiting just for me.

"Jeremiah, can you excuse me for one moment?"

Something told me that if he felt my thinly veiled attempt to rush him, that I might never have this opportunity with him again. I slipped out of the door to call Harry. "I have a situation here in the hospital. Can you pick up?" Harry groaned into my ear so loudly that I pulled pack the phone. "Babe, it's important."

"Babe! It's five-damn-thirty. I can't do it." ('Five-damn-thirty.' Oh, how my husband has such a lovely way with words.)

"Look, babe, it's important, okay?" Somewhere between another groan and the words, 'okay, but' he launched into his predictable Harry-style rhetorical questions. "So, when you need to work late, you can just call me at the 11th hour? When I need you to drop off without warning, can I just spring it on you? Can I just. . . . . " -- All that mattered is that somewhere in there, eventually, he said 'okay.' That was all I needed to hear.

I returned to Jeremiah's bedside visibly more relaxed and palpably more patient. "Okay, I'm sorry about that," I said gently as I settled back into the chair. His eyes still needed me. . . .

Then out of nowhere, Jeremiah looked at me and said, "Dr. Manning, do you like yourself?"

I turned the corners of my mouth downward, and grasped his question before answering. Then carefully, I replied, "Do I like myself? Yes, Jeremiah. I do. I really do." I pressed my lips together and paused for a second. "What about you? Do you like yourself?"

He looked out of the window wistfully. His dainty fingers were laced together over his abdomen. I could still see that he was shaking a little bit.

"Jeremiah?"

"Sometimes I wish I wasn't me. Sometimes." I waited to see if he would say more, but he just kept those lonely eyes fixated on some distant fixture in the Atlanta skyline. "Like. . . .somebody with different insides and feelings."

I could feel my every breath as I searched for the right thing to say or not say. I decided to keep waiting. I caught him looking at the ring sparkling on my left ring finger.

"You married, Dr. Manning?" I wasn't sure where this was going but I kept with him.

"I am."

"That's good. . . . " he murmured. His voice faded once again and came back. "If it was wrong to have feelings for your husband, Dr. Manning, what would you do?"

"Honestly, Jeremiah, I'm not in that situation, so it's kind of hard to say. . . . .are. . . you? In that situation, I mean?"

Without warning he buried his face into his slender fingers and began to weep. Hard. I reached out for his forearm, the closest thing I could touch. My first instinct was to start talking, but I resisted the urge.

"Dr. Manning?" he finally said with the trouble in his eyes reaching a painful climax. I opened my eyes wider fearing what would come next. I continued to hold his forearm in an attempt to brace myself just as much as him. "When I was in middle school, I used to. . . ." He started crying again and then slowly wiped his eyes with his palms. "I used to see a girl, and . . .and think. . .friend. . . or sister. . . ..but I would see a boy and. . ." Jeremiah's voice began breaking up with emotion.

"You're doing fine, Jeremiah. Doing fine, okay?"

". . I would have feelings for a boy like how you are supposed to like a girl. And I knew it was not right but I couldn't help it." He then let out this terrible, ashamed moaning cry that broke my heart. I was speechless. He sighed hard. "So when I grew older, I kept saying, I would stop feeling this way, you know? Like I kept asking to be changed into someone else with regular feelings, but I kept feeling like this. I would sing with all my might in church. Singing out to say sorry for feeling like this."

"Regular feelings? They're your feelings, Jeremiah." But this was more complicated than that.

"Why do I have to be like this? I didn't ask to be like this." He wiped his eyes with his forearm and stopped fighting the urge to cry. I waited patiently until the room fell to a hush.

"Does anybody know?" I finally asked.

"It would kill my mother. No. I haven't told nobody. . . .I never told nobody until now. . .I mean, my family is against that. Like they always suggested stuff, but they don't know. . . .nobody knows. . . ."

"So, there is no one. . .like, in your life?" I stammered.

"No . . . except there were some times that I did stuff. . .like. . .with . . .you know. " It was like he couldn't bring himself to say it, so I didn't make him.

"Somebody you knew well, or not so much?"

"Not. . .really at all. Like, more than once."

"You had sex?" He covered his face again and nodded.

"Okay," I said gently, "listen, it's not so much about if it was with . . .someone of the same sex as you. . .it is more about if you protected yourself and what you did."

"I didn't use nothing with none of them. I let them do everything. . . .but I wanted it . . that's bad I know. I just couldn't help it." Fat tears rolled down his cheeks again, his tiny neck being strangled with shame. He covered his face and shook his head again.

"It's okay, Jeremiah. It's going to be okay, alright?" I smiled and reached for his hand. "You are so brave."

"I don't feel brave," he whispered. I offered him an affirming squeeze. He took a deep breath and locked eyes with me. In his bravest voice yet, he said, "Do you think I could have HIV?"

I'm not sure why but I didn't hesitate. "Honestly? I think it's a real possibility. But I think you are in a safe place and knowing one way or the other would free you from worrying if you are."

"Okay. . ." he uttered in the tiniest voice possible. "Okay. . . ." Just then, I realized that he wasn't shaking any more.

"Flowers cannot bloom until it is their season. . . . .

as we would not be here unless it was our destiny. . . ."

Today, I am reflecting on how complicated the thin line between self acceptance and happiness can be. I am thinking of the loving interactions with my husband, the one I get to love without any one questioning or picking apart, that led to that single moment in time where my patient trusted me enough to be his authentic self. Every time I think of Jeremiah's quiet eyes and how they pleaded of me to stop and listen to him, I want to wrap my arms tight around myself. . .feeling thankful that I was dealt a hand that made it easy to be okay with me. Why? Because the older I get, the more I think that people who are the most okay with themselves are the most okay with others. That's my goal for myself, my children, and of course, my patients.

Thanks to several factors, most of which were completely out of my control, on most days, I'm alright with me. Because of that, a tiny part of me likes to think that there was something Jeremiah saw in my eyes that day, too. . . .something that made it okay to be honest with his doctor and with himself.

As it turns out, Jeremiah was indeed HIV positive and unfortunately also had advanced AIDS. But he got the help and treatment he needed, and even better, when he told his mother about his feelings, she hugged him and said, "It's okay, I love you, son." As simple as that. I still wonder if all along he'd known that his mother would be alright with the real Jeremiah, would he have eventually been alright with him too. . . .?

"Love the you that you see--you can only be you. . .as I can only be me."

Please take a moment to watch the amazing Stevie Wonder singing this haunting ballad. . . .
Today, I'm dedicating this to all of the Jeremiahs and to the Jeremiah in us all.

Random Reflection from a (Formerly) Cool Attending: Talkin' 'Bout My Generation

Me and Mom circa 1970 . . .before we lost our cool stock
(How rad is Mom's afro? I'm just sayin'!)

The Generation Gap. . . .

I used to pride myself on being a "cool" attending. Like, I was always familiar with the pop culture that permeated my learners' lives, and even received compliments on a fairly regular basis for the things I'd wear to work. There's something nice about having a 23 year old medical student ask you where exactly did you buy your shoes. I'd somehow managed for all of my thirties to stay ahead of that curve, reveling in my "cool" status.

It all started going downhill with me not being on Facebook. That was when I realized that I was the only person my students knew who didn't know what it meant to use the word "friend" as a verb. Somehow, I convinced myself that, despite this, I was still cool, telling myself, But look at your cool shoes, Manning! Come on, you still have it. You SO have it.

I still discover every day how much older I am than my residents and students -- like how none of them have any recollection of when MTV was just for videos, or can't recall when the non-buff Madonna writhed around on stage singing "Like a Virgin". There's also the moments when we discuss the point where we were in our lives when a particular song came out. . . . .they remember it as a pre-school memory, while I remember it as a high school after school dance anthem. And of course, there's the things like the aforementioned Facebook lingo that must be explained to me, or like how the students used Google images and Wikipedia to help me get what a "hipster" is. Regardless of all that, in my mind, I have maintained my cool position, and for the most part, stayed in step with most of my learners without actually feeling, well, old.

That is, until 40 started gaining on me. With the big 4-0 less than six months away, the generation gap has started to widen bigtime. . . . .and with that gap comes a few ticks down in the "cool" stock.

***

The end of cool as I once knew it. . . . .

I was rounding with my residents on the ward one day, and was in a rather playful mood. We'd all been full of giggles that morning, but had managed to stay on task enough to get through our eight new admissions. We listened as Dorothy, one of the students, presented the final patient.

She'd told us all about this gentleman who'd been admitted with an exacerbation of asthma. Fortunately, he was now doing much better. Dorothy reached the 'social history' -- the part where we discuss bad habits and living arrangements. "He doesn't drink, he doesn't smoke"--


"What does he do?" I interrupted quickly while letting out a goofy snicker. (Okay, yes, I know this was not the most professional thing in the world for an attending to do on wards, but I just couldn't resist the joke after such a perfect segue.)

"Pardon?" asked Dorothy.

"Don't drink, don't smoke--what do you do?" I sang with an accompanying finger snap. I chuckled again and kept snapping. . . . waiting for someone to join in. My dorky finger popping slowed down to an eventual halt.

Silence.

The team just stared at me incredulously, wondering what on earth I could be talking about. Not one person nodded in acknowledgment. In fact, they all gave me these uncomfortable, tight-lipped smiles; almost like they felt sorry for me for my unfortunate old school outburst and for this revelation that I was actually not a cool attending at all. . .but instead, quite the contrary--a lame one.

"Adam Ant?" I queried, "Adam Ant, y'all! Goody Two Shoes? You guys don't remember Goody Two Shoes?" I started snapping again. "Come on, y'all! That was a popular song!"

Crickets.

Um, yeah. Popular in, like, 1982. Turns out that not only had they never heard of Adam Ant or the song before, a fair number of them weren't even born yet when the song was on Billboard's 100. Wow. My "cool stock" clearly fell 100 points that day. Turns out that I was "talkin' 'bout my generation" -- literally. (That's what I get for being unprofessional on rounds.)

***

Jay Z (not T.I. and not LL Cool J)

The Generation Gap continues to widen. . .

It gets worse. Tonight I was watching the BET Awards with my mom, dad, sister and husband. T.I., a rather famous rap star, was on stage performing. Mom said, "This hollering on stage is really annoying. I can't see how you guys stand this."

"That's because you don't know what you're listening to," my sister replied dryly.

"Yes I do," Mom shot back, "I know who that is. That's JJ Cool Z." She was 100% serious.

JJ Cool Z? Wow, Mom. Really? And I thought I was lame.

(That was so worse than the Adam Ant outburst.)

***

These days, I've been redefining what it means to be cool. I've started wearing my "grown woman" status as a badge of honor, taking pride in what I've never heard of and enjoying the hairy eyeballs that my students and residents offer me after hearing me belt out the song of some one hit wonder from the early '90s. Anyways, it turns out that Huey Lewis and the News were right: "It's hip to be square."

Oh, and for those who don't get the reference, that's too bad. I'm talkin' 'bout MY generation, not yours. :)


***

Adam Ant singing "Goody Two Shoes" from the early MTV video days. . . . yes. . .this used to be a popular song, people!

Reflection on Thursday: Uploads, Downloads and Hard Drive Reboots

________________________________________________________

Do you ever have periods in your life where you feel like every drop of energy and productivity is being zapped out of you? Like. . . everyone and everything has their USB drives connected to you as their power source, but focused on their needs. . . . . . needs to download from your hard drive, but with very few uploads in return? I mean, I don't think it's on purpose. Sometimes it's the nature of where we are in our lives. People just need you. And while it feels good to be needed, it can be draining at times.

So that's where I'd been fairly recently. Drained. Finding myself stretched in so many directions sometimes that I can feel the seams popping . . . . .resident requirements, student needs, family life. . . . but wait--that's nothing new for me. What, then, makes it now feel so different?

The Difference . . . .

At the end of a particularly long day, I was sitting in the sunroom lounging on the couch. Slightly unusual that I was able to do this considering my kids were not only home, but very much awake. Lately the boys have evolved into being more tandem playmates than parallel playmates. This new arrangement keeps them occupied far longer, and affords me those periodic Calgon moments that used to be no more than fantasy. So there I lay on the couch. . . .mentally recapping my day. . .the highs and the lows. . . .I allowed my eyes to close. Ahhhhh.

"Mommy. Mommy!" I opened one eye and looked at Isaiah, standing in front of me with a Batman costume on. He leaned forward, close enough for me to smell his kid-breath, and repeated, "Mommy!"

"Yes, son. I hear you," I replied while closing my eyes again.

"Mommy, what does 'improved' mean?" he asked.

I rolled over, faced him, and met his eyes. I can always tell when Isaiah really needs my undivided attention. This was one of those moments. "It means you got better at something. Like remember when Mommy used to push you and Zachy in the double stroller, and I would get tired if I tried to run? And then I kept trying until I could run without getting so tired?" He nodded. "That means I improved. I tried and then got better."

Isaiah stood quietly for a moment, looking pensive. "It means at first you weren't doing a good job and then you did better?"

"Ummmm, not exactly," I responded, "It just means your hard work paid off."

"Oh," he answered while still looking concerned. I knew exactly why. Earlier that day, he'd participated in his "graduation" from Pre-K, and upon receiving his "diploma" he also received another special distinction-- "Most Improved."

His teachers somehow decided that all of the kids fell into two categories: "top achiever" or "most improved." Apparently, Isaiah didn't make their cut with the former, and --okay, I'll admit it-- I was slightly miffed. But after a while, I decided that I know my child and where he is cognitively. I decided to let it go. But Isaiah didn't.

"Why didn't everyone get most improved? Didn't everybody learn stuff and then do better?"

"You know what, sweetie? Everyone did learn and do things better. But maybe you did the most better." Most better? Really? I knew how crazy I sounded, and even more, I know my child. He would not buy this reply--no way, no how.

"I don't know if I want to be 'most improved.' Does it mean I had more trouble than them at first?" I sighed hard. Mostly because I didn't know the right answer to these questions, but also because I thought that the award and the very idea of giving such awards to 4 year old kids was complete bullshit. I wanted to look my son squarely in his eye and tell him just that, ending this conversation once and for all. But I couldn't.

Instead, I gently told him about awards and comparisons and how tricky that can be. How even Mommies feel funny sometimes when it comes to things like this, and especially so when it comes to their own children. Then I told him that he was special and wonderful and smart and amazing. He hugged me tight, and, literally, said, "Thank you, Mommy, for telling me that because I think I know a lot of stuff and when you say that it makes me feel proud of myself." Sigh. . .


So now I know what's so different. My children are growing older, and now they need more than just basic care. This, compounded with my professional life, gets pretty heavy at times. The downloads are no longer just diaper changes, cold milk, bubble baths or night time prayers. They now include questions like "what is improved?" or "are you proud of me?" or "why would God ever take a child to live in heaven?" The difference is that these types of downloads require more memory. . .and if I'm not careful to stop for a moment and breathe. . . .my hard drive gets drained and feels like it might crash.

Rebooting. . . .

Lately I've been trying to focus on the uploads and not just the downloads. I'm trying to be present enough to appreciate why those jumpdrives are attached to me in the first place. I've also been trying to slow myself down enough to receive what uploads I may have missed out on before.

A special upload. . . .

On last Saturday, Doug, one of my student advisees, got married here in Atlanta. I have known and advised him since his very first day of medical school, and through our unique curriculum at Emory, have had weekly contact with him since 2007 in a small group with 6 other students. He invited me to his wedding, and (being my perpetually five minutes late self) I managed to slip inside of the church moments before it would begin. Unfortunately, this meant that I was seated away from the rest of our small group, but nonetheless, I was thrilled to have made it just in the nick of time.

First came the organ music, followed by a soloist that sounded like a professional opera singer. This is nice, I thought. But then something happened. Doug entered with his groomsmen and the pastor. The minute I saw him walk in to await his bride at the altar, I felt overcome with emotion. I saw the first day of medical school, I saw the first day of clinical medicine, I saw the countless teaching sessions and mentoring sessions. . . .and somewhere in there, I saw my own sons. I willed myself to keep it together, 1) because I wasn't wearing waterproof mascara, 2) because it would surely lead to the ugly cry, and 3) because I was the absolute only black person there. (I figured that a hysterically crying black woman with raccoon eyes would not be such a good thing at this particular moment. . . .but I digress. . .) And so, this time I did the "pretty cry"-- complete with rapid mascara blotting, upward gazes, and eye fanning.

When the ceremony was over, I joined my student group in the vestibule. Doug walked up, and we congratulated him. It was such a moment, all of us there together supporting him on his big day. I could feel the upload--but just when I thought this was as good as it could get, he looked at me and said with genuine relief in his eyes, "I thought you weren't here. I looked and didn't see you with them, and I said to Anne, 'Dr. Manning. She didn't come. She's not here.'"

Anne touched his arm gently and added, "I told him you were here. I told him Dr. Manning would never miss this." Then she looked at him all new-bride-glowy. "See? I told you, Doug."

I couldn't believe what I'd just heard. That, with as much as he had going on, that he would not only think that, but actually take the time to say it to his new wife during his wedding. I chuckled to break up how intensely moved I was feeling. I looked at Doug and said, "Of course, I'm here, Doug. Of course, I made it."

He smiled and gave me a tight and genuine hug. "I'm so glad you made it, Dr. Manning. I mean that. I'm so happy you are here." And before I could even process the emotion I was feeling, he was whisked away to join his wife and family for wedding photography.

I walked out of the church and sat in my car for a few moments. I thought about how I had been feeling. . .how drained. . .how zapped. . .and then I thought about that moment in the foyer with Doug. It was the most perfect and simple reminder I could have ever been given about why I'm doing all of this. This is why you do this. This is what happens when you let people plug into you. And then I allowed myself to experience it, really experience it. . and then. . .allowed myself to cry. A tired, happy, and fulfilled cry.

Of course I made it.

I'm learning that the very best downloads I can offer don't involve diagnoses, or science, or complicated concepts. They involve relationships. . . . .and most times, just being there. Sometimes it's as simple as rolling over on the couch to face my son . . .and other times, it's just inconspicuously sitting on a lonely pew in a church full of strangers. . .quietly patting the corners of your eyes and wondering why you can't stop crying.

Members of my first small group circa 2010

My first small group as M1 students circa 2007

How do you spell relief?

Rocking the Pre-K graduation cap but feeling like I deserve to!

Ding Dong! The witch is dead!* *(At least for ten years, she is.)

Just received notification that I successfully passed that heinous American Board of Internal Medicine recertification exam. While it may not mean much to you, to me it means a whole lot. It means I get to do my job without worry or woe or threat of losing hospital privileges. In other words, it means I'm officially sho' nuff and bona fide to do what I do for ten more years. (Which is quite a relief considering it's probably poor form to be an academic teaching physician that isn't board certified, don't you think?)


Speaking of the ABIM recertification test. . . . .

Did I mention that I was asked to stop talking during the actual test? Umm. . .yeah, I'm not exactly proud of it, but errr. . . .well. . . . I have a tendency to talk to exams. Especially difficult exams. It's like I prepare for them, and then attack them full-on Rambo style like they're the enemy. I load up the ammo, put on my game face, and throw on my mental camouflage. Depending upon how I'm feeling, I might even tie a headband around my head and let out a primal war cry. It's me versus the exam, and I like to win. And this enemy was a doozy. . . . an all day computerized, no-coffee, no-snacks, no-nothin', difficult doozy. There I was. . . lying on my side in the trenches. . . .ready to pounce at a moment's notice, teeth gritted and machine gun bullets flying everywhere. "Aaaarrrrggggghhhhhhhhhh!" (That would be my war cry.) Okay, technically my "trench" was a testing center, and I was more sitting on a quasi-comfortable office chair than exactly down on all fours wearing battle garments in a dirt mound--but you get the picture. In a throaty, fairly diabolical (yet what I thought was a quiet and not-so-intrusive) voice, I told that exam exactly what I thought of it every chance I got:

"Ohhhh? Ha ha ha. . . you think I don't know that one, don't ya? Pneumonia and a brain abscess? Come on, playa. That's Nocardia, man. Don't try to play me! But that's a dirty question, man. Low down and dirty, man!"

It wasn't until after my third outburst, that the proctor came into the computer testing room and told me to put a lid on it. I take that back--she was sort of nice about it: "Umm. . . doctor. . . . I don't know how to say this, but. . . . well, there's actually no talking during the exam, okay?" What? You mean I can't talk during this test that required me to be fingerprinted twice before entering? Really? I'm sure she was thinking, Who does that? Uh. . . Dr. Manning, that's who. I bet money that I was subject matter for her "You ain't gonna believe what happened to me at work today" conversation at the dinner table that night. If only she'd known that my life is like one continuous Seinfeld episode, she would have understood. The good news? I don't talk in movie theaters, just extraordinarily heinous exams. The better news? I won't have to get muzzled again by her or anyone else until 2020! Woo hoo!

Me after getting Georgia ACP Outstanding Teacher Award
(looking calm considering I hadn't gotten a verdict on the ABIM recert exam yet!)


*For those who weren't reading this blog during my board review study period. . .check out this post to understand how challenging it is to study for anything as an almost 40 year old full-time working mama. . . . . whew!