Reflection on a Thursday: Seinfeld Reincarnated

One of the medical students told me recently, "Your life should be a reality TV show. Seriously."

I think he was right. My life is this amalgamation of "only Manning" moments that one would have to see to believe. It never fails. I have a "Seinfeld moment" every single day at Grady. Sometimes more than one.

Like today, for example, I was rounding with my team on our post call rounds. We were on the last of our ten new admissions, and the interns and I decided we'd make a pit stop at the Coke machine. Got my usual: a icy cold Diet Coke. Aaaaahhhh.

I tried to open it to take a sip. . . .grrrrrr. . . . .thought maybe my hand was too oily or something. Dried my hand off in my lab coat pocket and tried again . . . .grrrrrrrr. . . . . . dang, this sucker is screwed on tighter than I thought. Kept walking with team to last patient.

Now standing in front of room of last patient. Listening to Marc, one of my interns, tell me about his patient. Periodically. . .grrrrrr. . .struggling to . . .just. . . get . . .this . . .grrrrrr. . . .open. . ."Yes, okay, go on". . . .grrrr. . . .

Finally, Ben, the other intern, can't stand it any more. He steps in to help his damsel attending in Diet Coke distress. Kind of like Harry always does with a jar of unopened salsa, he did the silent hand wave signaling that with a simple pass it will be opened in an airtight-stopping, manly snap. No shame in my game. I hand it over. Marc politely pauses.

"Thanks, Ben. Go ahead, Marc."

Marc keeps presenting. I keep listening and writing on my billing card. . . . and, okay I'll admit it. . . periodically checking Ben's work with the airtight Diet Coke--more because I think it might explode in his face and not so much because I don't think he has the brawn to get it open. (I'm just saying.)

"Clinically, the patient looks much better than she did on yesterday," said Marc with that post-overnight frogginess that gets into one's voice after being awake for too long, "If things keep going in the right direction, we can aim for a discharge early tomorrow morning." In we go. Diet Coke waits on counter until we finish seeing the patient.

Eight minutes, one physical exam, one assessment and plan, and four or five Socratic questions later, Ben is still in the corner struggling with that bottle. Our fourth year med student, Barb, has even joined in on the task. Marc and I stop and just look at them--passing this bottle of Diet Coke back and forth. Ben's face is turning red with hypermasculine struggle. It's a pretty funny sight. Marc offered up a weak, post-call mini-smile (which, in itself, amused me.)

I can't help but start laughing at Ben's crimson face as he worked on getting his attending's thirst quenched. "Dude! What's up with you and this Coke? This will be reflected in your evaluation!"

Deadpan Ben hands the drink back to me and shakes his head slowly. He says to me with the most somber face he can muster, "Bad news, Dr. Manning. Your Coke is broke."

"What?"

"Your Coke. It's sealed shut," chimed in Barb with a snicker.

"Say what? I have an imperforate Coke?" (Recognizing my extremely lame use of medical jargon.) I study the cap incredulously--fused shut into one infinite plastic piece. Wow.

"Yes. It's official, Dr. Manning," Ben confirmed, "Your Coke is indeed broke."



A broke Coke? Seriously? Seriously.


See? This is my life. I just show up and live it, man.

Reflection on a Tuesday: I Heard THAT!!

Zachary concerto #1,442: Why can't we be friends?

Things I heard yesterday:

• Isaiah trying to whistle as I got him ready for school. It sounded like someone blowing out birthday candles to a tune, but he didn't seem to mind.
• The school bus blowing the horn for the five kids or so at the next stop after ours. None of them were out there yet.
• Zachary talking to me in his "sleepy guy" voice. The one that includes no real words. Just strange mumbling and random singing.
  
• My friend, mentor, and fellow Grady doctor, Neil W., talking about Alzheimer's Dementia on television before I went to work. Cool.
  
• My mom saying, "EXCELLENT!" when I asked her how she was doing this morning during a morning-commute phone chat.
  
• Two men in front of Grady laughing so hard that they looked like they would be sick.
• A lady talking on her phone in the Grady elevator as if no one was on the elevator except her. Like not even talking in the hushed-elevator-tone where you try not to say anything until you reach your floor. "Mmmm hmmm! Yeaaaaah, girl. . .I'm still here! Girrrrrl, you lyin'!! No she di'in't!!!" Funny.
• An environmental services worker who asked me, "You don't even look that thick in person as you do on Fox 5. See, I told somebody you was really regular-size! What you weigh? 'Bout 150?" (All while pushing an automatic floor waxing machine.) Huh?
• A patient I saw on rounds who was gasping for air from an asthma exacerbation, but not one so severe that she couldn't ask me, "Ex-ex-ex-cuse-cuse (pant, pant, wheeze, wheeze) me-me, doc-doc. . .where-where-where (pant, pant) do you-you-you get your hair-hair d-d-done?" Huh?
• A patient telling me that today's date is December the fifteenth, nineteen hundred and sixty eight. (But he did know that the president was 'Bama.") Huh?
• A sleeping elder wake up during my exam of her belly to say, "God bless you, baby."
• My cell phone playing an embarrassing ringtone on accident in the sleeping elder's room. Whoops.
  
• Dr. del Rio teaching the resident conference and me wondering in my head how he fits so much in his brain.
• A man with an oxygen tank asking somebody for a light (for his cigarette.) Huh?
• 3 and 3/4 year old Zachary in his car seat singing a loop of the same eight bars from this old R and B song for the whole commute: "Why can't weeee be friends? Why can't weeee be friends?" Huh?
• Isaiah crying when I wouldn't let him play "Angry Birds" on my iPad before homework.
• Harry waking me up off of the couch to do the second half of "bath-time."
• The kids reciting The Lord's Prayer. And, as always, Zachary starting it off with, "Our podder, art'n hebben, hoddobeedahname", and Isaiah ending it with two to three extra "ever and evers" before saying "Amen."
  
• The television when the episode of "The Closer" that I'd DVR'd ended. I'd fallen asleep on the starting credits and woke up when the DVR went back to the menu channel.
  
• The kids making their sleep sounds when I looked in on them: Isaiah with occasional teeth-grinding and Zachary with the weird tongue sucking/lip smacking thing.
• Those bizarre sound effects (a bird making kung fu sounds, swearing (?), and a pig snorting and laughing at you?) on that addictive little "Angry Birds" app. Couldn't help but play it in bed before falling asleep.
• Me and a mini-snore mid-game that woke me up--and Harry saying, "You need to go to bed."
• Me replying, "I heard that!"

_____________________________________________________________
The horribly addictive "Angry Birds" application. . . . . don't even go there. . . . trust me!

(my favorite TV appearance by Grady doctor, Neil W.--
the one where he brought his baby son on the set!)

Haiku on the Morning of a Grady Short-call Admission Day: Great Expectations

Six new admissions

Six new friends? Or foes perhaps?

Only rounds will tell. . . .

Reflection from the Grady Wards: You are Beautiful, No Matter What You Say

*details, etc. changed to protect anonymity. . .

"You are beautiful no matter what they say

Words can't bring you down

You are beautiful in every single way

Yes, words can't bring you down

So don't you bring me down today. . . ."



From Christina Aguilera's "Beautiful"

__________________________________________________________

"Those sores on your face. Is it from. . .picking?"

"Yeah, when I'm high I pick."

I studied her young face. With the exception of the handful of gouges on her cheeks and chin, it was a beautiful face. Pore-less skin like porcelain with striking blue eyes framed with the kind of eyelashes celebrities pay big money for.

"How long have you been using?"

"Uuuhh. . .what?"

"Using. How long have you been using the meth and the heroin?"

"Ummm. . .high school? Middle school? Man, I don't know."

She kept wringing her hands in her lap. A star was tattooed on three of her knuckles and her fingernails had been gnawed down to nubs. Both of her inner arm creases and forearms were covered with more intricate ink; perhaps to camouflage needle tracks from the average onlooker. But to a doctor working in a public hospital, the shiny scars that distorted each tattooed image were exactly like seeing a hand caught inside of a cookie jar full of intravenous drugs.

"My resident mentioned that he'd spoken to you at length about getting some help. I know this is a lot, but we really want to offer you some help. A new life. When you came in, you could have died. You aren't even 25." I paused and tried to get her to make eye contact with me. "I'm so happy that you are doing better. This could be a second chance, you know? What do you think?"

:: shrug ::

She brought her filthy nails up to her teeth and began nervously chewing at the little piece remaining. Perfect teeth, like dentures. Unusual for someone who used methamphetamine, but reason for me to find her that much more striking than I already had. She was beautiful.

She gave up the nail-biting and moved to scratching her arm. She let out an exaggerated yawn. I was boring her, I could tell. I felt like I needed to at least ask.

"Have you ever been in a treatment center?"

:: yawn ::

She craned her neck from side to side as if removing a "crick." That's when I noticed the sprinkles of needle marks dotting her jugular vein like purple confetti. The drugs had destroyed all of the vessels in her arms and legs. Or maybe not. Maybe the neck was just faster. Closer to the brain.

I stared incredulously at this beautiful stranger. How did this happen? How? I imagined her sitting cross-legged on the floor of her pre-school during "circle time." Raising her hand high for the teacher to pick her. I saw her turning cartwheels on a bright green lawn in front of someone's house and laughing at a kitchen table until milk squirted from her nose. I could see her as somebody's baby, peering up at someone with those same haunting blue eyes, and them whispering a lullaby to her in a rocking chair. I felt a pang of grief for the loss that that same someone is probably feeling at this moment. . . .

"Can I go?"

I stared at my billing card and registered her current clinical state: respiratory status, kidney function, and hydration all back to normal. Evaluated by Psychiatry, but declined treatment. Not suicidal. Decision-making capacity intact. Still precontemplative about rehabilitation. Clinically, appropriate for discharge.

I startled myself when I uttered aloud, "You are so much more than this. . .and you're so beautiful." I am still surprised that I spoke that part, but I went on. "You are so much more than--"

"What time can I go?"

Save the sermon, her expression told me. The only two words she had for me and my soliloquy were "over" and "it."

That's when I had to accept that she wasn't ready, and that I wouldn't get the satisfaction of seeing her leap from the bed and hug me in gratitude for guiding her to a new life. I had to accept that most times it isn't that way, but you still have to try. What if this was the day for her? What if God was counting on me to encourage her and I didn't try? Sometimes I wonder if I'm just being Pollyanna or high-on-my-horse to think that, in a person this far from ready, any thing I'd say would make any kind of difference whatsoever.

I circled "discharge" on her card.

"Right after lunch," I answered her flatly. Suddenly I felt very sad.

"That's okay, I'm not hungry. . . .can I go before that?"

"Okay, then as soon as we complete the discharge paperwork--maybe a half hour?"

Then she smiled wide and beautiful and genuine; the first smile I'd seen since we met that morning on rounds. She didn't even try to hide her happiness with that verdict as she fished around in the bed sheets for her cell phone. She poked the phone keys with her stubby thumbs, entering a feverish text to whomever would clearly be her savior from all these folks caring and preaching and asking her all these questions.

"Thirty minutes, right?"

"Yeah," I replied, "or less."

____________________________________________________

For some reason this song kept playing in my head after I saw this patient . . . . and for the rest of the day. . . . . praying she is okay and that she eventually sees what I saw.

Reflection on a Sunday: Early Morning Haiku on the 15th Day Rounding on Grady Wards

Keep hitting the snooze


Cuddling versus rounding?


Weekends blur with weeks. . . .

Reflection on a Saturday: TB or Not TB? That is the Question.

acid fast bacilli of Mycobacterium Tuberculosis

  ______________________________________________________________

I got stuck in a Grady stairwell last week. I entered one of the locked stair entrances behind someone else who'd just gained access using their magnetic badge. I thought nothing of it. I mean, it's not like I needed the person to be all super-nice and let me into the door like some kind of visiting medical student. I mean, I'm on staff here. My badge works. But if someone wants to offer me an act of chivalry by holding a door for me to enter the stairwell, I'm cool with it. Completely cool with it.

But the chivalrous house officer who let me in bid me adieu at the 9th floor. I gave him a wave and kept trudging up a few more flights to the 12th. Huffing and puffing, I touch my badge to the plate waiting for the red light to turn green signaling an unlocked door.

::clunk::

That was the sound of me trying to pull open the heavy metal door. That's weird. I carefully separated the badges on my hook to make sure I was using the right access card. Let's try this again.

::clunk, clunk, clunk::

Damn. I was locked in the stairwell. Like a visiting medical student. No, worse than that since, now that I think of it, even visiting medical students have working badges.

I looked at my badge and. . . . awww shoot! "7/2010" was the expiration stamped boldly across the bottom it. I smacked my hand against my head. Aaaarrrggggghhh! The dreaded expiration lockout.

::clunk, clunk, clunk:::

(Visiting medical student) "Uhhh, Dr. Manning? Is that you?"

::clunk:: "Errr. . .yes, can you let me in please?"

Access granted. By a visiting medical student, no less.

Super.


***

You see, at all hospitals, but especially public hospitals caring for folks from literally everywhere, badge renewal comes with one special little rite of passage: the PPD or TB skin test. For those who aren't in the medical field, a PPD test is something that looks to see if you have been infected with tuberculosis. And seeing as folks in hospitals randomly cough and hock all sorts of things near you, on you, and around you--every year, it is the hospital's responsibility to the public to make certain that one of those folks didn't bless you with some acid fast bacilli (such as tuberculosis.)

I was supposed to have my badge renewed by the 31 of July, which means I needed to get a PPD test first. Okay, I'll admit it, I dropped the ball. I kept "forgetting" to take care of it. . . .that is until last week when I had to be rescued from a stairwell by a visiting medical student. Great.

So. . . . I hang my head and shuffle up to the 15th floor to get my TB skin test. Here's how it works:

You enter the Employee Health Clinic.

They ask you, "Is this for badge renewal?"

You say, "Yes, ma'am."

They say, "Let me see your badge, baby."

You say, "Yes, ma'am."

They take your badge and look at it. If you are a good egg with an unexpired badge, they smile and hand it back to you. If you're a hard-boiled (aka hard-headed) egg (like me), they see that your badge expired in July when it is now August. Then they ever-so-subtly turn the corners of their mouth downward and ever-so-audibly say, "Ummm hmmm." This is followed by a much deserved hairy eyeball as they hand your badge back to you, searing you with a scarlet letter for being a menace to the society (and public health.)



They inject you just below the skin of your forearm with this TB detection potion. If you're unlucky, it causes your arm to explode into a big red mound at the injection site if indeed you have been infected with TB. Oh, and it takes a minute to resolve. Um, yeah. That's pretty much how it works.

the positively positive puff-daddy PPD (with control)

When I say "infected with TB" I don't mean sick with consumption and coughing, per say. Millions of folks are "infected with TB" but it lies dormant in their systems. A positive PPD just means you've been exposed and infected at some point--but it doesn't mean you will get sick. Taking medication for 9 months after finding out you have the dormant or latent type of TB usually keeps it knocked out like Sleeping Beauty. So what's the big deal?

Okay, so here is my confession:

Sigh. I know I need my TB skin test every July and . . . .admittedly, I don't actually forget completely. At risk of sounding horribly horrible, I'll admit that:

• 1) I am annoyed that my badge is up for renewal during the hottest, most humid, most short sleeve bearing time of the year since

• 2) I have this secret fear of having an exploding mound on my forearm for the entire summer if I have indeed converted, and

• 3) It would really suck to have on a lovely sundress in July accessorized with a positive PPD. . . oh yeah and,

• 4) for the 48 hours after I get the test, I can't help but to chronicle every patient I've met all year who coughed, belched, sneezed or showed me a basin, cup or kleenex filled with giant, blood streaked lougies for my inspection. (I mean just maybe they could have been teeming with tubercles. I'm just saying.)

What happens to me every year:

• 24 hours after getting my skin test, the site is itchy, red and a little bit puffy. Oh no. Was it the man in the elevator who coughed from the ground floor all the way to the 12th last winter?

• 36 hours after the injection, the puffiness is mostly gone, now it's just red.

• 48 hours later, it's just red. Whew.

(For the record, a certain number of millimeters worth of puffiness, not redness, is what counts as a "positive" PPD test.)

Looks like my PPD is red, yes. But puffy? No, ma'am.

48 hours on-the-dot later, I skip into Employee Health all happy that I am no longer a menace to public health and society. I pull up my lab coat sleeve and show her my left forearm. Ting. (That's me smiling at my clean bill of health.) When I notice the nurse looking at my red (but not puffy) forearm, I decide I don't like the silence. Rut roh. I feel myself having a Grady flashback from four years ago with my PPD skin test reading.

Oh no. Not again.

See? It's always drama when it comes to me and the PPD. As mentioned before, every year, there's some preservative in the TB test potion makes my arm turn red, puffy and slightly itchy for the first 24 to 36 hours. During that time I get to worry and wonder if I've converted this year, (and nearly burst into flames in the 100+ degree Atlanta heat while wearing long sleeves to keep folks from asking me, "Ooohh! You PPD positive?") So far, that reaction has always subsided--leaving behind a small, flat red spot. For the most part, once they see that it's red but not raised, it's all good. For the most part with the exception of four years ago. . . . .

Employee Health circa 2006:

"Hmmmm."

"It's red but not indurated," I protested. (indurated = hard, puffy)

"I don't know about this, baby. . . .I don't know."

"Nuuhh uuuuhh!" I started feverishly rubbing my hand over my forearm and before I knew it, was defending myself like a 5 year old. "It's flat, see? It's not puffed up."

The nurse looked at me and shook her head. "I don't know, baby. . . ." she repeated.

She ran her hand over my arm a few more times and then said, "Come with me."

::smush smush ::click click:: smush smush::click click::

(that was the sounds of my heels following behind her nursing clogs.)

::smush smush ::click click:: smush smush::click click::

I walked behind her to what I thought was going to be the next room to get a second opinion from the other nurse. Nope. She passed that room and two more nurses. We kept walking. Down the hall, through a door and into another hall. Around a corner and yet another hall to a door, deep in the bowels of Grady. The nurse rapped on the door softly and waited for a response.

"Enter," a raspy voice commanded. My pulse quickened.

We opened to door and -- maybe it's exaggeration but is my recollection that the door creaked open slowly and a gust of smoke flew from beneath it. The first thing I see is an intimidating-looking woman with reading glasses hanging on a chain around her neck. (I am convinced that this is akin to meeting Yoda or The Wizard of Oz or the Oracle from the Matrix.) As soon as we crossed the threshold, she rose from her desk and slid the readers onto her nose. She slowly approaches me offering not even the slightest expression that could be mistaken for a greeting or welcome of any sort.

Instinctively, I thrust my arm out in front of her. Gulp.

Without uttering a word, she studied it with her readers, and then glided her hand over the red patch on my forearm. I held my breath and waited for the verdict.

::rub, rub, rub :: smack! ::

Pulling the glasses off her nose, she turned her back to us and muttered, "Negative."
And that was that. The master had spoken. No questions. No "but don't you think this part is questionable?" No back talk. Best of all? No TB for me (at least that year.)

Ever since then, I break out into a cold sweat when the time comes for me to get a PPD test. . . .one part vanity from not wanting the possibility of wearing a red mound on my forearm all summer (I'm just saying. . .) and one part PTSD from walking the green mile with that nurse to go see the Dumbledore of PPD readings.


Fortunately, I passed my test this year, too. And without having to get a second opinion. Whew.

***

Today on my hospital rounds at Grady:

:: clunk, clunk ::

Turns out that once you let your badge expire, you have to go to the secret badge dungeon even deeper in the bowels of Grady to get it reactivated again. . . .but that's another post for another time. . . . .

my so-called renewed badge (I look so happy 'cause I'm PPD negative this year.)

Morning Haiku: Reflections on What I Heard This Morning Before Even Getting Inside of Grady Hospital

acrylic on canvas by my brother, Will Draper, DVM 6/94
(who must have intuitively known that I was destined to be a Grady doctor)

__________________________________________________________

Sounds while walking in:


"Doctor, can you spare some change?"


"I like your hair-do."

______________________________________________________________________________

I love this job. :)

Reflection of a Kindergartener's Mom not Mommy: The Underestimator

Have you ever underestimated someone? Like thought one thing about them, only to learn that they are bigger and badder and braver than you realized? That's what happened to me on Isaiah's first day of kindergarten yesterday.

I thought he might be a little shy, overwhelmed, or maybe that he might withdraw a bit until he was comfortable. But that's not what he did.

He got on a big yellow school bus without us.
He made his way to the cafeteria without us.
He went to a new school and a new class with new people without us.
He even rode another bus after school without us.

And while I was freaking out (so much that I came to get him super early) he was not. He was so not.

We sat in our favorite frozen yogurt spot talking about the day. He looked puzzled when I said, "Yes" to gummy worms as a topping when I usually say, "No." It's because I was so proud of him that I wanted him to have a treat. But again I underestimate him. He said, "That's okay, Mom. I know you don't like me eating those because they give you cavities." And he was right.

I thought about how relaxed he looked. I noted that he called me "Mom" and reflected on my friend Kris R. who brought to my attention that having your child transition from calling you "Mama" to "Mommy" to "Mom" are big deal milestones. He was readier than I thought. I underestimated him.

This made me think of this resident I had in my program a few years back that seemed so shy and almost self-conscious. He was quite possibly the most humble person I'd ever met, and was so gentle that it almost seemed like a facade except it wasn't. It was him. But I underestimated him. I mistook gentle and humble for lacking assertiveness.

All of the interns had to give these lectures to their class, and it was his scheduled day. I waited for him to be nervous and soft-spoken and watched to see if he had a tremor when holding the laser pointer. But he didn't. I underestimated him completely.

Turns out it was one of the most superior lectures I have ever seen given by a trainee. He was confident. He was prepared. He was calm. He demonstrated expert prowess and navigated every slide and subsequent question with aplomb. I thought I learned that day to never underestimate any person's abilities.

Guess I'm still learning. On the second day of school, Isaiah ran down the driveway and onto the bus with a quick wave.

"Bye Mom!" he yelled, "See ya later, alligator!"

I wanted to cry when I answered him back and blew him a kiss. "After 'while crocodile."

Reflection from a Tuesday on the Wards: Let Her Cry

*minor details changed. . . yeah, yeah, you know the deal

"Let her cry. . . .
if the tears fall down like rain. . . .


And if the sun comes up tomorrow,
let her be. . . .let her be."


from Hootie and the Blowfish's "Let Her Cry"

_________________________________________________________

Have you ever been right on the tippy-tip edge of crying but manage to avoid crying by taking a few deep breaths or stopping-dropping-and-rolling before someone hits you with "the concerned look?" Well that's where I was the other day on the wards. Right there. On the brink of a ripple of emotion that could easily be nudged into a tsunami. Fortunately, I was rounding alone that day.

So there I was. . . . just me, my patient's chart, a nurse's clipboard with vital signs and a medication administration record--quietly wrapped up in a cocoon and waiting for these feelings to pass. Stay on task. . . talk to no one. . .write your note. Over and over reciting in my head, Please nobody come up to me. Please nobody come up to me.

No such luck.

From the corner of my eye I saw Ben, one of my interns, walking toward me. Oh no. Please don't start talking to me. No, not now, Ben. Please don't strike up a conversation.

"Hey, Dr. Manning," he said. "How's it going?" Eek eeek eeek.

I offered him a tight lipped smile. Please don't ask anything else. Please don't ask anything else. That's when he hit me with it. "The concerned look" followed by the dreaded "concerned question."

"Uuuhhh, Dr. Manning? You okay?" Damn.

The last sandbag before the levee breaks. . . . . . those two dreaded words: "You okay?" ( The only thing worse is the unsolicited hug.) Anyone who has ever been on the tippy-tip edge of being about to cry knows what happened next. Yup. . . sigh. . . .I started crying. Right there at the chart box in front of my poor unsuspecting, one-and-a-half-month-in intern (who happens to be male.)

Nope. No exaggeration.

Here's the thing: I had just got through talking to my patient and his daughter about his new diagnosis of widely metastatic cancer. One that couldn't be cured short of some divine intervention. In other words, I just told somebody who, just the week before had been minding his own beeswax and living his own life that now all that was about to be cut short. Real short. And that made me sad. . . .

Now understand that this gentleman was pretty up-in-age, but still. Bad news is bad news and like my late grandmother (Mudear) once told me when we sat side by side on a church pew at her younger sister's funeral, "Don't matter how old you get, your baby sister is your baby sister, your momma is your momma and your daddy is your daddy."

And you know what? It wasn't that they didn't take the news so well. Quite the contrary. The patient and his daughter took the news amazingly well. But every time I looked at his daughter (who was in her sixties, by the way) all I could think was, "Don't matter how old you get, your daddy is your daddy." Then I thought about my daddy. I thought about what age would be acceptable to me to hear that kind of news, and thought, um, the age of never. That made my heart swell a bit, but it wasn't even that part that took me to the tippy-tip edge of crying.

It was what this patient said in response to hearing about his diagnosis. This robust, elderly gentleman--I'm talking a gentleman in every sense of the word--sat there on the edge of the bed holding his daughter's hand with his legs comfortably crossed in front of him. She was holding a bible, which, now that I think of it, she always seemed to be holding every time I saw her. Instead of crying, she was looking at her daddy smiling. In fact, the only one who wasn't smiling was me. He looked at me with those wise, octagenarian eyes and said:

"Why you look so sad, doc? Don't be sad 'cawse I ain't sad. Babygirl, let me tell you something. I been here eighty plus years and God been good to me. Good, do you hear me?" (Every time he said "good" he patted his hand on the bed for emphasis.) "I ain't 'fred a no cancer. I done traveled the whole world, known a true love, had some wonderful chil'ren and more grands and great-grands than I can even count. So if cancer is His will for me, then so be it. I'm okay with that. 'Cawse good as God been to me, babygirl, I mean good as He been to me"--(he stopped and shook his head and tapped his foot while his daughter nodded in agreement)-- "The least I can do is accept His will. I mean it's the least I can do in return."

::sigh::

Something about encounters with my Grady patients who have that kind of intrepid faith moves me in the deepest parts of my soul. Problem is, when the deepest part of my soul gets moved, I almost always cry. No matter where I am. And if I'm not careful, it can evolve into "the ugly cry" quicker than you can say "Rumpelstiltskin." That said, I quickly managed to excuse myself from my patient's room to avoid unleashing the tears, let alone the ugly version of them.

"God bless you, sir," I managed to eek out before leaving.

Whew, that was close. I stepped out of the room, into the hallway, and did my best to disappear inside of the chartbox. I swallowed hard and coached myself to not cry--knowing that if I waited long enough, the emotion might just melt away. Unless provoked, of course.

But that's when my earnest, young intern did just that. Strolled up with "the concerned look" and asked me "the concerned question."

"Uuuuhh, Dr. Manning? You okay?" Dang. Here we go. . . . .

Poor Ben. He had to just stand there while I cried. Staring at me with this weird mix of empathy and freaked-outedness. Wondering if he should hug me or smack me. Or both.

Turns out this wasn't the first time this had happened to me. Or the second time even. Once I cried so hard about a patient in front of my resident (now one of our chief residents), Roy A., that I'm pretty sure I scared him. It was pretty mortifying. . . .but that particular day I was so overcome with emotion that I just couldn't reel it in. I know I spent a few days avoiding eye contact with Roy, which as you can imagine, was pretty hard since we were caring for patients together. Later that month he told me that he appreciated how invested I was, and that seeing me cry had taught him something. Roy helped me realize that revealing that vulnerability, especially when you're trying to be a role model, can sometimes can be okay. Actually, more than okay. Sometimes it's necessary.

So thanks to Roy and thanks to the wisdom that comes with time. . . . instead of feeling embarrassed at that chartbox, I saw it as a teachable moment. Allowing a novice physician to witness a more seasoned one humanizing a patient and the family connected to them.

And so sometimes I say forget it and let myself cry. . . managing to keep it two breaths short of the ugly kind. But I don't fight it. I honor what my patients give to me by not fighting it. I honor what this patient is teaching me by not fighting it.

Besides. . . . .it's the least I can do.

Celebrating the Least of These: Happy Birthday to "Reflections of a Grady Doctor!"

Wow! Can you believe it's been a whole year since I started this crazy thing?

From those who have been reading since August 8, 2009 to those who just started reading today--thank you. Getting these thoughts out of my head and into these stories seals their places in my heart forever. I find myself not wanting to forget things and people and situations and lessons. This has been a joyful place to keep them--I'm so glad this medium exists and that you've been there for the ride.

As corny as it might sound, "Reflections of a Grady Doctor" has been a therapeutic, productive, and important journey for me. It feels like a celebration of public hospitals and the indigent patient population, clinician-educators, health care providers, mommy-hood, wife-hood, family-hood, friendship, spirituality, and everything each teaches me along the way. The fact that anyone other than me (and my parents) reads this is touching. . . . and even more, it's like a loving punctuation mark on the end of every sentence I type.

Thank you for reading. Thank you for sharing. Thank you for feeling. :)

~ Kimberly Manning, MD (aka gradydoctor)

"The King will reply, 'I tell you the truth, whatever you did for one of the least of these brothers of mine, you did for me."

~ Matthew 25:40