Sigh.

A much-needed nap interrupted: The worst and yet the best.

Cool thing I read today:

"The worst things about being a parent
are still better than the best things about every thing else."

~ Will Arnett, actor and husband of SNL funny-lady Amy Poehler

"So I could read it."

Lame, I know: my #1 follower

Author and Nobel laureate Toni Morrison didn't start writing until she was almost 40 years old. The first book she ever published, The Bluest Eye, is one of my favorite books of all time.  When somebody asked her why, after all that time, she'd decided to write that book she said, "So I could read it."

I heard that.

A medical student recently asked me, "What prompted you to start writing this blog?"

Hmmmm.

Okay. . . it's true that I write this blog to honor patients, their stories, and to underscore the ups and downs of fighting for work/life balance. No question. But now when I think about Ms. Morrison's words, I realize what I should have said:

"So I could read it."

I think that's also part of the answer to the question I hear the most frequently: "How do you find the time to do this?"  We find the time for the things that are important to us. And this has become important to me, so I have to find it somewhere. Nestled between that moment when I first wake up to those first few seconds that the kids break the morning silence. Or intertwined in those few hours after the last Dr. Seuss book and falling asleep with a book in my hand. Even if it means not watching much television. Or talking on the phone a little less. I have to find the time to do this.

So I can read it.

Nope. I'm no Toni Morrison, but I sure relate to her impetus to write. Reading my own stories has made me a better doctor, a better teacher, a better mommy, a better wife, but most of all, a better friend to myself. It's given me a golden opportunity to visit with me regularly and often, sometimes laughing out loud over an early morning cup of joe or "ugly crying" into the crook of my own elbow late at night until I'm out of breath and tissue.

Yeah.

It's an honor to know that anyone has spent even a moment of their day reading what I've written. Seriously. And I'm the first to admit that sharing these thoughts and hearing affirmations nudges me to keep at it.  But deep down, I admit: sometimes I can't wait to finish a story. . . .just so I can read it. And learn from it.

Lame, I know.

My friend and fellow Grady doctor, Neil W., calls me a "free-style" writer. Kind of like those rappers who rhyme off the top of their heads without scribbling or erasing my words off of a notebook multiple times before performing for a crowd. He's right. Most times, I just have to get it out so I just type, type, type. . . and (thanks to my mom, the queen of "girl, you have two typos in that post and 'eachother' is NOT one word for the millionth time,'") my "free-style" approach works. .  .and has made this a surprisingly painless form of self-exploration. Taking the time out to do this is a gift I give to myself, my #1 reader.

That's been one of the most surprising perks of doing this. I've gotten so much closer to me.

(Lame again, I know.)

I now believe that everyone should have some kind of activity that allows them time to befriend themselves. In doing so, you quickly find that you are the friend who is always willing to try that new restaurant, to hear the same stories about what your kids are up to over and over again, and not mind being tapped into late at night for last-minute advice (on the same damn issue--again.)

I'm not sure what you do to befriend yourself. . . . .

But I hope it's something. For me, it's writing. About everything and about nothing. And these days I'm thankful for this electronic labor of love that has forced me to take pause in this hectic life and spend a little time hanging out with someone who has finally become my BFF--me. 

****

What do you do to connect with you?

***

Here is a neat essay on finding the time to do something meaningful like writing, shared with me by my blog-friend Lisa R. (Thanks, Mama-smacksy! )

This is the remix.

At the end of proctoring a clinical skills/physical examination test last week, I told two medical students this during the feedback session:

"Whatever you do, do it with as much zeal and as much confidence as you can muster. If you've prepared, there's no reason to shrink and hide in the shadows. In fact, no one wants you to do that. Don't be afraid to infuse your own style into it. Make it your own."

I noticed that they'd both done a wonderful job preparing for the exam. They knew every single thing that they were supposed to know. Interestingly, though, these students and several other learners I've encountered over the years were . . .how can I put it. . . self-deprecating to a fault. Apologetic, even. Yet they had no reason to be! I did my best to punctuate that session with a "you go, girl!" moment, just to make my point.

It took me a while to reach that point of being used to hearing my own voice in medicine.  I remember being stunned and overly celebratory whenever something came out right. One day during my 4th year of medical school, my classmate Jada M.R. and I were having dinner with this accomplished black female attending. We had just gotten our USMLE 2 scores, and were over the moon because we had done well. She looked at us with disdain as we chattered about how elated we were. Then she told us these pivotal words:

"Why are you so surprised when you do well? That's a shame. You need to tell yourself that your preparation is enough, and that you are the bomb--over and over again. Until you believe it."

  Of course we graduated. We worked hard. We prepared. We deserved to.

(with Jada at graduation in 1996)

I've held those words close to my chest ever since. I tell myself those things often, and I tell my husband and children the same every single day.

Today I'm reflecting on the importance of self-confidence. Sometimes you just have to get in the corner and shadow box for a few minutes to pump yourself up, even when you're feeling unsure. And no matter how nervous it makes you, sometimes you just have to get off of the ropes and start swinging as hard as you can. There's so much that holds us back just because we're too afraid to say, "Let me in, coach!"

So.

To everyone out there who is trying their hardest to do something with zeal and with confidence and with non-shrinking-ness and with an infusion of their very own--albeit different--style. . . . this is your nudge to get those shoulders back and that chin up and do just that. This is your nudge to ask the coach to let you in. And to inspire you, I bring you the perfect example of zeal--courtesy of the "king-of-dancing-like-no-one-is-watching" himself--my four-year-old son, Zachary:

"Hey Diddle Diddle, The Country and Western Remix" by Zachary M.

(Digitally remastered at Manning Home Studios, 11/5/2010)

 (He also has an extended version of this remix that he sang in front of his class Friday--and a B-side version of "Hickory Dickory Dock" that is equally reminiscent of Waylon and Willie coming soon to iTunes. . . .)

Now if that ain't zeal, tell me what is?

Life. Make it your own, people. Don't hold back. Expect to do well. . . .

. . . and don't be afraid to do an unexpected remix.

Reflections of a Former Chief Resident: The Ultimate Excuse

(Art by Shel Silverstein)

____________________________________________

"I cannot go to school today," 
said little Peggy Ann McKay,

"I have the measles and the mumps, 
a gash, a rash and purple bumps. . .

What? What's that you say? 
You say today is. . . .Saturday?

G'bye! I'm goin' out to play!"

~ from Shel Silverstein's "Where the Sidewalk Ends"

____________________________________________________

Back in the day when I was a chief resident, I used to hear all kinds of excuses. Most of the time, they were legitimate, but every now and then, they'd border on completely crazy. For those who don't realize exactly how the chief residents' facial expressions look on the other end of the phone when you call in (or call back after being "drafted" for a Jeopardy call) with "awww HELL naw"-worthy excuses. . . .I'll show you. . .it looks a little something like this:

"Awww HELL naww!!"

Case in point, right now, I'm reflecting on this phone call I received early on a Saturday morning circa 2001:

"Heeeeyyy Kiiiiiimmmm." (read with very dramatically raspy and quasi-sickly voice)

"Hey. What's up?" (read with superdry voice to squelch dramatically exaggerated and quasi-sickly energy.)

"I feel like I'm about to get a migraine. . .ooooohhhh. . . . so I can't come to work."

"ABOUT to get a migraine?"

"Yeeeeaaaaah. . . "

"Umm, so DO you have the migraine or not?"

"Not yet, but I know what it feels like when it is about to happen."

"Umm, so why don't you, like, take some medication now and come a couple of hours late?"

"I think it could make me drowsy."

"Does it usually? I mean, like, make you drowsy?"

"Not always, but sometimes. . . . I'm just not sure about taking ICU call today. . . . or in 4 days. . ."

"AWWWW HELLL naw!"

As time has marched on, I have heard some more winners--one of my all time favorites being the one where the resident "accidentally" took two Benadryl allergy pills like, right before she was supposed to come in, and was just too drowsy to drive in to take call. . aww HELL naww!

Or. . .no, THIS is the best one. . . the one where this intern had terrible, terrible stomach cramps so terrible that he couldn't even make it out of the bed to even consider trying to come to Grady, yet I actually frickin' saw him with my own two peepers standing near the stairwell in the parking garage looking tearful while having some kind of heavy duty, love affair-looking discussion with another (female) resident.

Really? Wait -- did this dude just call off "brokenhearted?" Aww hell naw!

Listen. I don't mean to be insensitive. I, too, had my share of early morning internship tears over a wobbly love mix cassette tape (yes, I meant to say "cassette tape.") But I never called off for it. Nor did I insult my attending by making a call from what sounded like death's front door or at least an infirmary--when I was in the building!

So when he called in quasi-sick I said, "Uuuuhh, didn't I just, like, see you? Like here-here at Grady? Like here two seconds ago in the parking garage?"

And would you believe that he said, "Nuh uh, Dr. Manning, that wasn't me."

Wasn't you? Wait--is this dude trying to play me?

(throwing hands in the air and kicking over a chair) AWWWW HEY-UULLLL NAW!!

Now, let me just say for the record: The vast majority of the medical students and residents with whom I've worked have been absolutely spot on and professional with regard to disclosing the rare situations when they must miss work. But for those who just can't seem to get their excuses together, I offer you an alternative. Yes, against my better judgment, I will share with you what I have learned to be the one thing I could hear that would not lead to the hairy eyeball.

Yes, today I bring you. . . . .wait for it. . .wait for it. . . .

The Ultimate Excuse.

Now. Let's just be clear here. I don't recommend making excuses for absences. I suggest telling the truth up front, as it is always the easiest thing to remember. However, if you are going to fabricate something. . please. . . don't insult our intelligence. (Or as Harry says, "What do you think my name is? Boo Boo the Fool?")

For all of my non-doctor, non-medical student readers, The Ultimate Excuse works for you, too. I must add that my knowledge of The Ultimate Excuse is not because I have personally used it. It's instead because I've heard so many "Awww hell naaaw!"- worthy excuses spanning from my chief residency in 2001 to my current role as a residency program director that I feel 99% sure that I have damn near heard them all.

What makes an excuse The Ultimate Excuse, you ask? It's simple. The Ultimate Excuse must be:

Believable.

Kind of unfortunate (enough to make people feel a little sorry for you.)

Self-limiting (meaning it will improve without a doctor or hospitalization.)

and, gender-neutral.

Most important, however, for an excuse to be The Ultimate Excuse, it must have one main quality--it MUST be something that NO ONE WILL ASK YOU MORE QUESTIONS ABOUT. Period.

Now with doctors, this is tricky. I mean, what kind of illness can you tell a doctor that you have that won't garner more queries?

"I have a horrible headache so I can't come in to take call."

"Is it a stabbing headache? A dull throb? Any visual changes?"

"Ummm. . . . ."

"Let me see what I have here in my purse. . . .great! Just found a sumatriptan in here. . . . this will work wonders. . . .see you in twenty minutes!"

"Damn."

And so. This is why you need to know about The Ultimate Excuse. Just in case you need to keep it behind a glass box that you can break open and use in case of emergency.

Oh yeah . . . The Ultimate Excuse also works wonders for legitimate problems taking you out of work, too. You know. . .the ones that could be slightly embarrassing like hemorrhoid surgery or mid-week laser hair removal for a female goatee. This calls for a zippy one-liner that welcomes no further comments. (Even from a nosy person like me.)

Is the suspense killing you? Let me give you a musical hint. . . .

This anonymous juvenile songwriter in my neighborhood put it so eloquently:

"Put yo' hand on yo' hip

Put yo' foot on the floor

Make a fifty yard dash

to the bathroom door. . .

People think it's funny
but it's really kinda runny. . ."

Yep. You guessed it. Diarrhea.

Diarrhea. . . . . aka The Ultimate Excuse.

Don't believe me? Try it this on for size:

"I can't come in today because I woke up early this morning with. . . horrible diarrhea. Man. . .like every 5 minutes! It's . . . .uh oh. . .hold on for a second. . . "

Genius, I tell you.

No one wants to know more details.

No one wants to discuss it upon your return.

No one wants to come by to see you.

No one wants to explore its legitimacy.

Period.

This is why I maintain that diarrhea is, hands down, The Ultimate Excuse.

And it's so versatile, too! It works equally well for:

Not wanting someone's bad ass kid to come over for a play date.

Not allowing someone in your house because it is a mess.

Not talking on the phone to someone you'd prefer not to speak with who keeps calling you.

A solid explanation as to why you missed the Tupperware Party, Silpada Party, Pampered Chef Party, insert any kind of retail party that you would prefer not to attend.

(Gasp. . .cannot believe I said that part out loud. This is hypothetical, people. I am not saying that any of this is from experience.. . . ahem.)

Hmmm. Though I have never attempted this. . . .Ladies, The Ultimate Excuse would likely work perfectly on those evenings that you are feeling. . .say. . . . .less than amorous. . . .(I'm just saying)

Aaahh yes. . . .Diarrhea--The Ultimate Excuse that shuts everyone up.

You never have to worry about those pesky exploratory questions:

"Is it runny? Watery? Gooey? Voluminous? Explosive? Malodorous?"

or follow up questions like:

"How is your diarrhea today? No longer runny? Watery? Gooey? Explosive?"

Instead, all you get (accompanied by zero eye-contact and barely even a hug) is this:

"Heeeyyy. . .errr. . . welcome back. . . . uuuhhhh. . . did you watch the Housewives last night? That NeNe is something else, right?"

"I was sick, remember?"

"Errr. . .oh yeah. . .ummm. . .would you. . .uhhh. . . like some hand sanitizer?"

***

See what I mean?

(You're welcome.)

_________________________

*Disclaimer:

The Ultimate Excuse is not for casual use. You can only have but so much diarrhea in a one year period. Overuse of The Ultimate Excuse will guar-OWN-tee you the following reaction from your chief resident, program director, boss or spouse at some point:

"AWWWW HEY-UULLLL-to-da-NAAWWWWW!"

It's a love thing.

image credit

I could never hide the feelings
That come over me
When you're near me
I know that's how it's supposed to be
My heart is telling me. . . .

It's a love thing. . . .yeah.

from The Whispers "It's a Love Thing"

______________________________________________________

This past Monday was the most "fall" of the fall days I'd seen so far this year. The kind of air that's so crisp that it shoots straight up your nostrils and opens your nasal passages like strong peppermint. And the colors. . .grass, so gloriously green. . .the sky, so breathtakingly blue. . . and the leaves. . .oh, those beautiful leaves! With each gust of wind, they rise up to meet you. . . swirling around your feet and head in a palette so rich that it can only be compared to that moment when black and white Dorothy landed in technicolor Oz. . . . . .the kind of beauty that makes you know for sure that there has to be a God somewhere that had something to do with it.

Yeah, kind of like that.

This past Monday was one of those kinds of autumn days.

I took in its beauty as I parked my car in the space that this official-looking woman in a long skirt and dark clothing pointed to for my car. "That's fine right there," she said. I nodded and turned the steering wheel in that direction. Right behind me in her car was my friend and fellow Grady doctor, Stacy H. I watched her straighten up her wheels to get them as close to the edge as of the curb as she could. In the passenger seat beside her was Joanne, one of our Grady administrative assistants. I slid on my coat as I watched her step out of Stacy's van and onto the grassy shoulder. Joanne offered me a half-hearted smile. Stacy did the same.

We walked in silence for a few seconds; our feet in synchronous reluctance. No one knew what to say.

"God sure smiled on this day, didn't He?" I finally uttered. It came out kind of awkward.

"Yeah. . . " Joanne politely replied. Stacy just glanced at me and tried to smile again. This time her eyes were glistening with tears.

We reached the top of the grassy knoll where scores of people huddled solemnly below and around a green tent. A rabbi spoke in a hushed and calming voice. This was in stark contrast to the unabashed singing and bellowing ministers I was used to in my own culture. The traditional African-American "homegoing celebration" would probably feel like being in a foreign land for the many in attendance. But as I silently listened to unfamiliar prayers spoken in Hebrew--one similarity rang true: This was not something any of us wanted to do.

I clutched my chest and drew in a deep breath when my friend and fellow Grady doctor took the podium. Her arm was locked tightly in her sister's; her face a solid mask of pain.

"I want to thank each of you for being here. Our mother was an amazing woman, a devoted wife, and a committed mother. . . ."

Her voice began to break, but she quickly regained her composure. Sniffles rose and fell amongst the mourners. She was strong and brave to stand there. She even said a few funny things about her mother that made those who knew her mother smile.

Watching her grieve hurt me deep in my soul. I wanted to push through the crowd and tell her how sorry I was. I wanted to cry with her and to hold her hand; the doctor in me hoping that those things might be therapeutic. But what do you say to a child who just eulogized her only remaining parent? How tightly can you hold her hand to make her not feel afraid and alone? That thought made me cry.

Suddenly, while I was weeping into a tattered piece of napkin, something happened. It was as if God Himself tapped me on my shoulder and whispered in my ear, "Don't be sad. Take this in. No, not just the fall colors and the cool weather. This. Take this in."

And that's what I did.

Here's what I saw:

First, what I saw was a crystal clear autumn day. But then I saw nearly one hundred people standing shoulder to shoulder in honor of my friend's mother. I saw hands. Some holding the person beside them, some wringing shredding tissues, and a few masculine ones securely placed on the yarmulkes that mother nature repeatedly tried to blow off of their heads. I saw several medical students shivering outside of a tent in dark suits; one of whom had very, very recently had a baby. I saw Grady doctors young and old, current and former, patting tears from their eyes or hiding them behind dark shades. There were childhood friends flanking the family fiercely, and there in the center of it were the two sisters. Two sisters, one an attorney and the other a doctor, both of whom sat in those very seats eleven years before when they lost their beloved father. Two sisters who, since that time, had become two wives and two mothers each of their own two children. But that thought--it was too much. That made me cry more.

I felt that soft tap on my shoulder again. "Look again. Don't you see it? If you did, you'd not be sad."

Just then, I saw it . . . .I really saw it. And just like that, I stopped crying.

Here's what I saw when I looked again:

I saw children who grew up to be whole. I saw kids who became true friends to others and decent human beings--a sparkling testimony of the very best any parent can ever hope and pray for in a lifetime. In that moment, I saw what happens when two young people meet each other, fall in love, get married and then have two children that they parent with all of their might. I witnessed what happens when a man and a woman carefully hand down traditions and teach their children to embrace their culture and faith.

What I saw wasn't a black thing or a white thing or a Jewish thing or a Christian thing. This was a love thing. And in that love thing, I witnessed the perfect outcome of what happens when a mother's eyes and a father's eyes light up whenever their children walk into the room.

Those children become the kind of people that others love. The kind of people that draw countless friends out to stand with them in quiet solidarity in the middle of a cool autumn business day with virtually no notice. Some because they personally knew your parent. But many others who only knew the love they instilled in you, their children--so for you, they had to be there. Which really means they were there for them after all.

I thanked God for revealing that to me, and as soon as I had the chance, I hugged my friend and whispered in her ear the very words that had just been given to me:


"You represent the very best your parents had to offer this world. Your life is their greatest opus and the swan song for them that never ends. Always remember that."


I felt her trembling body burying muffled sobs into my shoulder, yet somehow it felt strangely peaceful. Just then, something else was revealed to me in that moment: As doctors, we don't just need to take care of our patients. We need to take care of each other, too.

I put that on a mental post-it note so that I wouldn't forget it..

When I walked back to my car, I could feel the temperature outside getting a bit warmer. I lifted my chin and let the November sun caress my cheeks. My tears had all dried and something in my heart felt celebratory. I squinted at the intense sunlight and paused. I promised myself to keep this moment as a reminder of what "love things" can achieve.


Yeah. God had smiled on this day indeed. And there was nothing awkward about it.

________________________

*for AB and AB, may your swan song never end and your love thing never die . . . .

The Last Word.

Two weeks ago, my son Isaiah demanded that I do a few things while in the car with Zachary and him "from now on." :

1. Not talk on my cell phone, even with an "ear-bug."
2. Not make them listen to NPR with me.
3. Especially not make them listen to "Fresh Air" on NPR . . . .which they giggle at profusely when the host says "I'm your host, Terry Gross"--like she's really gross or something.
4. And since I won't be doing 1 through 3, talk to them instead. (Unless, of course, I want to pop in a DVD and let them watch TV or play on my iPad, which negates 1 through 3 and allows me to do the default "whatever you feel like doing, Mom.")

It's actually worked out quite well so far. First of all, it's a wonderful way to grow your kids' vocabulary and to see what's going on with them. Second of all, it's a great time for bonding. Kind of like the kitchen table, but without the kitchen or the table.

Here is our unabridged conversation that took place on the way home two days ago. Brought to you straight from the back seat of Mommy's thinly veiled attempt at avoiding the mini-van a.k.a. the Volvo SUV (which equally screams "soccer mom" . . .sigh. . .I know, I know.)

Isaiah:  "Hey Mom?"

Me:  "Yes, Poops?"

Isaiah: "Mom, why did you want to be a doctor when you grew up?"

Me:  "Hmmm. I think I wanted to be a doctor because I wanted to help people."

Isaiah:  "But you can help people even if you aren't a doctor."

Me: "Okay, sick people."


Isaiah:  "You don't have to be a doctor to help sick people."


Me: "But you can't tell them what's wrong or give them special medicines if you aren't a doctor."

Isaiah:  "Remember that time when I told you that Zachary had a fever and you said, No he doesn't, and I said, Yes he does? I knew what was wrong with Zachary and I am not even a doctor.

Me: "But you couldn't give him special medicines, though."

Isaiah:  "You couldn't either, Mom. You called our pediatrician, remember?"

Me: "That's because it's not good for me to be you and Zachy's doctor."


Isaiah:  "Then why be a doctor in the first place?"

Me: "Because being a doctor is . . . . cool."

Isaiah: "Well, it's not so cool if you still have to take your kids to the doctor after learning all that stuff."

Silence

Zachary: "Mommy?  I'll be a doctor, okay? Does that make you happy?"

Me: "Zachary, I want you to be what makes you happy. Wait, I mean what makes you happy and gainfully employed enough to live by yourself in your own house and not with me."

Zachary:  "Okay then I don't want to be a doctor I want to be a ninja."

Me:  "Do ninjas get a paycheck?"

Zachary: "Ninja turtles do."

Me: "Cool beans, dude. Works for me."


Silence

Isaiah: (brow furrowed) "You know, Mom. . . .If I were a. . . painter, I would definitely paint my own house. Definitely. Seems like it would be dumb to learn how to be a painter but have to call in another painter to paint. . . .especially if you are real, real busy. "

Me: (in mirror to myself)  "What the . . .?"

Isaiah:  (folds arms and smirks) "That's what I think about that, Mom."

Silence

 (Terry, I don't think you're gross.)

Terry  Gross through my VERY LOUD radio:  "You're listening to Fresh Air, and I'm your host, Terry Gross. . . . "

Well, that's what yo' mama thinks about THAT.

Kick Buttowski.

Trick or treat for us went a little something like this:

"Trick or Treat. . . .or pay the price, suckaaaaa. . .waaaaaaaaaaahhhhh. . . .bssshhhh! Bssshhhh!" (Sound effect of waaaay too violent pretending. . .)

This is what went on from house to house....to house..


Ummm. . .did I fail to mention? One of the homes where this took place was that of the DEAN of the SCHOOL of MEDICINE. (100% truth.)

Picture it:

Ding dong!

Dean: "Well, hello there!"

My child: "Trick o' Treat! Or pay the price. . . "

Me: "Whooaaa. . .uh. . well, hello there sir. . . . .uhhhh. . ."

My child: (with round off kicks on Dean's front porch) "Waaaaaahhhh! Bshsshhhh! Bssshhhh!"

Dean: (just smiling, no words as small black child threatens safety of his family)

Dean's wife: (with expression that I can't fully put my finger on) "Ooohh, now aren't you just so energetic!"

::sigh::

Ummm. . . . yeah. Know anyone hiring?

****

Hope y'all had a fun one, too!

Cover me.

photo credit

I remember this one time when I was talking to one of my Grady patients who was dying of AIDS:

"What can I do for you today?" I asked him.

"You can pray for me. By name."

"Ummm. . .okay." That was all I could eke out.

"Will you really?" he pressed. I still remember his gaunt face and hauntingly sad eyes. He was serious.

"I will, sir. I . . I will." I was serious, too.

Later on that afternoon when I was sitting in my office, I replayed that encounter. I thought about his request for me and my promise to do what he'd asked. Right then and there, I closed my eyes, clasped my hands and did just that. Prayed for him. By name. When I opened my eyes again, I felt good. Like I'd offered my patient something much more than a prescription or a diagnosis.

Here's the thing: That particular day, I'd felt so frustrated. I felt helpless in that patient's overall prognosis and like nothing we were doing for him was working. Every day, it seemed like there wasn't anything I could do for him. So this time, I admit that I was slightly relieved that he actually had a suggestion for me that I could at least consider: "You can pray for me." Whew. I think I can do that. But heal you? Cure you? That would be much harder. . . .

For the rest of the hospitalization, I kept it simple, just like his question. Every morning on rounds, I would try my best to not be distracted by anything. Then I'd just hold his delicate hand and ask, "How are you, my friend?"

And.

I also remembered to pray for him. Not in just the "God bless all my patients at Grady" way that I had habitually done before. This time I prayed for him by name. Just as he'd asked. Now that I think of it, I kind of liked the added nudge to be specific.

Today I'm reflecting on all of the things we can do for people that go beyond prescriptions or medical knowledge or material objects. Sometimes our therapeutic alliances (and relationships in general) are strengthened by our authentic presence, be that physical, emotional or even spiritual.

There's this song I like called "Cover me." It's about asking a person to pray for you. It immediately came to mind when my patient made his request. I like to think that "covering" each other goes far beyond prayer. . . . .

Yeah.

Regardless of what you believe, here is something I'm pondering today that I hope you will, too:
 Oftentimes when people ask to be kept in your thoughts and prayers, they mean it. I know this patient did.
____________________________________


Remember to cover me
That I might go in peace
Remember to keep me lifted
That I might go in spirit
Keep my name on your lips
When you pray remember this:
I need you to cover me.


Remember to cover me
That I might go in peace
Remember to keep me lifted
That I might go in spirit
Keep my face on your mind
When you go to God next time
I need you to cover me.

from "Cover Me" by 21:03 (hear it here.)

________________________________________________
~ to my dear friend and fellow Grady doctor. . . .you know who you are. Your face is on my mind, my friend. Know that I am covering you. I am.

Love actually.

*details, specifics changed to protect anonymity. . . .you know the deal.

photo credit

A friend called me one day in tears. "I'm never going to get married," she moaned. "Ever. I'm so unlucky in love."

"Trust me," I responded, "There is somebody for everyone. Really. Just be patient. Trust me, I mean it."

"But I think some people just have crappy luck when it comes to love. I am a loser magnet."

"Stop speaking it, man. You have to stop speaking it or the universe will hear you."

"Okay," she whimpered, "Okay."

And that ended our conversation. I bet you think I was drawing upon my wonderful epic saga of when Harry met Kimberly when offering up those encouraging words, don't you?

Well, I wasn't. I was thinking of Grady Hospital.


How I know that love is out there for everyone:

This one time at the Gradys, I was seeing a Grady elder with one of the residents. And what a patient he was! The first thing I noticed about him was his infectiously positive attitude. This was remarkable, considering some of his other features.

He had exactly one tooth remaining of the thirty-two that he'd started out with, and that sole survivor was riddled with decay. Oh that lonely incisor. . . it was buried on each side by a heap of inflamed pink gingiva, yet had somehow migrated exactly to the center of his upper gumline. His face was covered with pasted on "moles"-slash-flat warts, and his lips kept a constant supply of white, frothy saliva tucked in each of their corners.

Aaahh, but it didn't stop him from smiling.

He had a poorly controlled case of diabetes which left him with one below the knee amputation, and because of his limited workout schedule, his stout midsection looked like a spare tire, literally. And just to give you a better sense (pun intended) of this particular patient, let me add that he wreaked of some dank odor that was possibly urine or something else.

Now, y'all know by now: I love me some Grady Hospital. But even more than I love me some Grady Hospital, I love me some Grady patients. And even MORE than I love me some Grady patients, I love, love, love me some Grady elders. So please. . . .know that when I say this next statement, it is with nothing but endearment:

This dude was no chick magnet.

(But somehow, he never got that memo.)

"Haa-haaaaaaahhhh!!!" he'd cackle and slap his knee during the encounter. It was this awesome-front porch-in-a-rocking-chair-happy-grandmama-or-granddaddy type laugh. Unabashedly loud and boisterous. No hand in front of his mouth. No embarrassed, slumped shoulders. No skittish eyes. Not this dude. He was cool with himself.

And as it turns out, he wasn't the only one. I learned that when I returned to discuss his treatment plan with the resident physician who'd been seeing him that day. We'd painstakingly made adjustments to his insulin to account for sky-high blood sugars, his blood pressure medicines to account for failing kidneys, his pain medicine to account for horrible neuropathy, and his cholesterol medication to account for his soaring lipids. The patient had only completed 4th grade, and, though motivated, had very limited health literacy.

We carefully explained the entire plan step by step. We drew pictures, we asked questions, we had him repeat what had been said to be sure he understood. After he understood the medical aspects of his visit, we explored aspects of his home life to be sure he wasn't getting overwhelmed. Fortunately, he had plenty of support from his adult children and friends. He'd been widowed for several years, so I feared that he was isolated and perhaps at risk for depression. A few quick screening questions confirmed that this was absolutely not the case. He was fine. And especially fine with himself.

So, that was that. We prepared to wrap up the visit with this moderately obese, virtually toothless, diabetic, and amputated gentleman in a room that seemed made for containing this urine-ish odor in its every crevice. But somehow his pleasant attitude and outlook on life overshadowed all of that. We helped him back into his motorized wheelchair and prepared to bid him adieu. I decided that he'd be my F.P. (favorite patient) for the day.

"Doctor?" he asked as I put my hand on the doorknob to leave.

"Sir?"

"I almost forgot to ask y'all--I wonted to see if I could get me some them Viagras. I ran out of the ones I had got from a friend."

Say wha-wha-whaaaat? (Imagine me on a turntable scratching a record like a very surprised deejay.)

The resident and I exchanged glances. I spoke first. "Errr. . . .sir, are you. . .umm. . . .do you. . .have a lady friend?"

Great Manning. You're the attending, remember? That's officially the lamest way ever to ask a patient if he was sexually active. Decided to try to fix it. "I mean, sir, are you currently having sex with someone?" Great. Even dumber.

"Well yeah! Or else'n why would I be askin' for the Viagras?" He let out that giddy laugh again. "Me and my lady-friend been friends for years, and got close a while back after both our spouses passed on. We old, but we ain't dead!" And this time winked.

Ummm. Yeah.

I looked at his chart and noted that he wasn't on any nitroglycerin containing medications (which would make medications like Viagra a no-no.) The resident explained that his erectile dysfunction issues (or "nature" as he referred to it) could be from his diabetes and possibly something that might not respond to medications like. . .uhh. . Viagras.

"Nawww, it work for me jest fine," he countered and winked again. He still had that big gummy smile when he added, "My lady-friend out in the waiting area, and I know she gon' be glad I remembered to ask."

Exactly.

***

This morning, I'm reflecting on a few simple yet poignant lessons that this patient had to offer:

1. Attitude is everything.
2. What matters most is how you see yourself.
3. Never assume that a patient doesn't have the kind of sex life that warrants Viagra. (Or Viagras.) And most important?
4. There is a lid to every pot--even if it's buried so far in the back of the cabinet that you think it's nonexistent. Even when you lose your first lid, another can await who lost its pot.

See? Now surely my morose girlfriend's prince charming is out there somewhere. And who knows? Maybe he's a frog sitting in a waiting area somewhere just waiting to be kissed.

E.M.Arrrrggghhh!

Good news:  

Grady Hospital is "going live" on our new electronic medical record (EMR) in less than one week. 

Bad news:

Well, actually. . . there's no real bad news per se. But there are some aspects of overhauling the medical record system of a ginormous hospital system that qualify as annoying, to say the least.


The main one?  The training sessions! And it's not because we don't have a wonderful team of trainers who are eagerly walking us through this electronic system. It's not them at all. It's us. The doctors. Getting us scheduled, making sure we "get it", and much, much more. There are several four to six hour training sessions that we must complete prior to the "live" date--some of which are even on weekends. It's a necessary evil for an overall positive endpoint, I know.

But Sunday at 7am? Really?

Now. .  .let me give you the visual. . . .a six hour session with twelve doctors sitting in front of twelve computers.  A very efficient teacher praising us for "getting it" so fast and agreeing to shave off an extra fifteen minutes of the session with every "good job!" compliment.  And, most importantly, a new found knowledge of our massively upgraded, generation Y charting system -- all ending nearly two hours before the intended end time of the scheduled session. That doesn't sound too horrible, right? Right.

Unless.

You get in a session with one of the following types of people:

1. The "excuse me, I didn't get that, so can you back up and repeat the last five trillion things you said over the last five trillion hours?" doctor.
2. The "I don't know my home keys on the typewriter so I keep getting behind so then I turn into #1" doctor.
3. The "jump ahead because I am too impatient to wait and learn and listen so then I get locked on some weird page that requires the instructor to stop and deal with me" doctor.
4. The "I'm so OCD that I can't get past the inaccuracies of the medical problems in your practice patient examples so I will continually correct the non-doctor instructor to insure that every example is evidence-based" doctor.
5. The "I'm going to keep checking my Blackberry/iPhone/Droid because there is no way I can go two minutes without texting an emoticon-laden message to someone sitting in this training session with me" doctor.
6. The "what? I've been in the wrong room for the last two hours?" doctor.
7. The "sorry I'm late, but I was in the wrong room for the last two hours" doctor.
8. The "I scheduled all my trainings out of order so, even though this is '102' I'm going to keep asking five trillion annoying questions because I actually haven't even done '101'" doctor.
9. The "even though all eleven other want us to keep plowing through the training so that we can get out early, I do want the offered breaks even if it means not leaving until the full six hours is up" doctor.   And last but not least,
10. The "all I want you to do is give me credit for being here so will ask an alarmingly off-based question that suggests that I have not paid attention to a single thing you've said for the last five trillion hours" doctor.

(Feel free to offer suggestions for any I may have missed. . . )

So this is what I (and all of my fellow Grady doctors) have been going through for the past several weeks. Is there a deep point to this?  Uhhh, probably not. But today, I am reflecting on how hard change can be.  It's interesting to see how set in our ways we can all be (me included.)  Change throws everything into a tailspin. Even when it's necessary.

Funny thing is when it's all over, you sit there scratching your head and trying to imagine life before/without the big change you kicked and screamed about just a few months/years before.  This will surely be no different. Oh, and for the (electronic medical) record, I refuse to admit which of the ten EMR training personalities I fit. On second thought, I've been a perfect angel, so clearly none of those apply to me. Heh.

Bottom line: This change is a good thing.

But still. I will still periodically let out my war cry:

E.M. ARRRGGGGHHHHH!!!!