Sweet dreams.

"Hey, there. . . " Give a gentle shoulder shake. ". . .hey there, sir. . .it's Dr. Manning."

"Errrrrrrrrrr." Tossing. Grumbling. Hunkering into covers. In that good kind of rapid-eye-movement sleep.

"I'm sorry to wake you. . . "

Opens one eye over shoulder. "Awww, hey there, Miss Mannings." Pops up in bed. "Whew! That's okay. I'm waking up now."  Rubs eyes. Big smile. With a stretch.

Big smile back. "Hey back. How are you?"

"Good. 'Cause I was dreamin'."

"How's your symptoms?"

"The same, not better. But not worser."

"Really?"

"Yeah. . . ."

This hand dealt to him was not a good one. A bad diagnosis complicated by a bad social situation. Get you better only to discharge you to a shelter where everyone is doing the bad things that landed you in this predicament.

Damn.

Look in your eyes. Feel your neck. Reach deep in your armpit for possible lymph nodes. Feel your heart with flat palm and then listen to it. Please sit up. Deep breaths, okay? Next the bowel sounds, fast and gurgly. Palpate your belly, skinny and scaphoid. Does that hurt? Inspect your skin. Feel your pulses. Then grab your hand with brown finger tips from cigarettes.

"Your test is coming up this afternoon, that's why they didn't give you a tray."

"That's cool."

"Did you have questions about it?"

Still rubbing eyes. "No'm. I'm good."

"Okay."

Stand there for a few seconds. What to say next?

"Sir?"

"Yes, ma'am?"

"What can I do for you this morning?"

"Honestly?"

"Honestly."

"Just let me fall back asleep so I can get back to that dream." Sighs with big smile and closed eyes. "'Cause everything was good in that dream. Everything."

Staring for  moment. "I can do that."


Walk to the door. Look back at my patient. Getting closer to being discharged. Almost better, but not really. Same but not worser might be the only attainable goal.


"Lights on or off?"


"Lights off. Thanks."


***
 Now playing on my mental iPod. . . . .

Dream babies

children of night

what do you dream?

Is anything real?

Or does it just seem?

Is everything wrong?

Is anything right?

What do you dream, babies, tonight?

Where do you go in your dreams--can you fly?

Do you ride any rainbows--touch at the sky?

Or do you find yourself nowhere--do you see yourself alone?

What do you see in your dreams--way up high?

Do you find pretty patterns catching your eye?

Or do you find yourself falling?

Do you wake up with a cry?

Dream babies

Children of night

What do you dream?

Is anything real?

Are your dreams made of colors?

Or just black and white?

Is anything right?

What do you dream, babies, tonight?

~ from the Broadway Musical, The Me Nobody Knows, 1971

Twenty-twos.

Us on rounds yesterday: Size matters.

Tuesday on Work Rounds:

Me: "Did you hear that heart murmur?"

Intern: "No. . . I didn't hear it."

Me: "That's because your stethoscope is too long."

Intern: "What? It's the same size as yours."

Me: "Ehhh, no, sir. 'Tis not."

Intern: "Is."

Me: "Isn't."

Student: "I didn't hear it either."

Me: "You need a twenty-two incher."

Intern: (holding up stethoscope) "I thought mine was the short one."

Me: "Naaah. Not as short as mine." (holding up my even shorter scope)

Intern: "Darn. I cut mine to make it shorter."

Student: "Really?"

Me: "I've cut a few in my day. But don't go cutting up stethoscopes. Just get a twenty-two."

Student: (eyes widening) "Whoa. Is it really better, Dr. M?"

Me: "Well, it depends. You are more likely to get coughed on, barfed on, accosted, licked on the cheek or infected with TB since you're only twenty-two inches away. But you won't miss any heart murmurs."

Student: "Shweet!"

***

I love the medical students.

This ain't the only time you need to be rollin' on twenty-two's.

Three is a magic number.

So. . . .since I have been on this School House Rock kick with the kids, tonight we realized that we neglected to mention two of the very best ones of all!

Three is a magic number.

Okay. . . . so today I was watching this one (Three is a Magic Number) with Zachary and decided that I was hormonal since something about the lyrics and the Paul-Simon-ey way it was being sang choked me up. (Crazy, I know.)  It made me think of when we first took Isaiah home from the hospital. . . . .

"A man and a lady had a little baby. . .yes, they did. . .

There were three in the family. . .that's a magic number."

::sniffle::

Then it made me think of my blog-friend Lisa R. and her wonderful family of three people + three pet-people--if you count her cat Pearl who is now in kitty-heaven. Then I started sniffling some more thinking of Rachael C. who is having baby number three, which is special for more reasons than you could realize. So yeah. . .I got a little wave of emotion thinking about Lisa's three + three and Rachael's baby # 3 and also remembering me crying in the backseat riding home from the hospital with newborn Isaiah. Okay, and I admit--I just might be hormonal or, as Harry says, drama-ful. But either way there's no arguing it--that three? It's totally a magic number.  



And last but not least. . . . .how dare you say even two words about School House Rock without asking this very simple question:

Conjunction junction. . .what's your function?  (Didn't you just love the raspy dude's voice?)



*(Lesley M., thanks for the almost-comment.  I added these two just for you and the "Black Diamond Boys".)

Reflection on the Ides of March: Three minutes.

*names, minor details changed to protect anonymity.

Ready in three minutes.

This whole exchange took place yesterday while I was (very busy) typing my notes at the nurses' station in the afternoon. The daycare pickup clock was ticking. . . .

The entire incident happened over a three minute period.

_______________________________

"Excuse me, ma'am?"

I looked up and saw a woman in front of me. Her face was smooth and youthful, but troubled. And not troubled in that "do you know where the women's clinic is?" kind of way, but more of a troubled in that "I'm getting evicted" kind of way. I removed my hands from the keyboard to show her she had my attention.

"Could I ask you a quick question?" she asked. I immediately noticed that she was wearing what looked like a Grady employee badge, so I now knew for certain that she wasn't lost.

"Sure," I replied, now curious about her furrowed brow and searching eyes.

She let out a big sigh and then said, "Okay, so like. . . .if somebody got the AIDS, right? Well, not the AIDS where you real sick, but the AIDS where you just got it in you and then you wear a necklace on your neck and put it in they mouth. . .you know, like a cross on a necklace. . . and nen somebody else put it in they mouth, do that mean they can get the AIDS, too?"

Wait, huh?

I decided to say that out loud. "Wait, huh? I'm a little confused. How about you tell me exactly what happened so that I can help figure it out with you."

I noticed that she was panting a little bit while she was talking to me. Her right hand was tremulous and her eyes had become glassy while giving the first explanation. She was worried. Like, real, real worried.

"Okay, so explain what happened to me--" I reached my hand over the counter and grabbed her wrist, "--and take a deep breath. So far, this doesn't sound like it is much of a problem, okay?"

She took a deep breath, but it didn't seem to help. "Okay, so. . . . like my close friend. . . he. . . . he got the AIDS. . .but he go to the doctor and he don't be sick or na'n. . .like he say he don't even have it to that point like thet or na'an."

"So, he is HIV positive is what you're saying?"

"Yeah, ma'am. Tha's what he always be correcting me saying. That it ain't the AIDS but iss really the HIV in his body that they keeping from being the AIDS."

"Your friend sounds pretty smart."

"Yeah, ma'am. We grew up together. He, you know what I'm sayin', be with dudes and stuff but we been friends since we was real, real little. So he like a brother to me. And, you know what I'm sayin', he trust me and told me about thet."

I leaned my chin into my hand and just listened to her.

"Okay, so wha' had happened is that he was at my house and he was playing with my baby daughter. Well, she really like two, but you know she like my baby, you know what I mean. So he was holding her and stuff and I went in the kitchen and nen when I came out she had his cross on his necklace in her mouth."

I turned my mouth sideways and squinted my eyes. "Okay."

"And nen I was like, 'Oh my God! Get that out her mouth!' And he was like, 'What you trippin' for?' And I was like, 'I seen you with that in your mouth when you was texting when you first got here!' And then I start screaming at him why he let her put thet thang in her mouth when he know he jest had it in his mouth." She was shaking again. And now she was sweeping away thin tears that were sneaking down her cheeks.

"Oh my goodness. What did your friend say?"

"He got all mad and left. Like he said, 'What kind a friend are you?' And I said, 'Eff that, tha's my babygirl.' So for two weeks I been reading up tryin' to find out whether my baby got the AIDS now."

Two weeks? Damn.

"What's your friend's name?"

"Justin."

"And what's your name?"

"Nika."

"Okay, Nika. I'm Dr. Manning." I squeezed her wrist again. "Listen to me, okay? Even if Justin had the cross in his mouth two seconds before your baby did, that isn't something that you need to be worried about."

She didn't look convinced.

"Nika, the way you get HIV is if it's in some blood you get, which almost never happens now. If you shoot up with somebody's needle, you can get infected." She gave an exaggerated shudder--the kind people often give when they want you to know that they'd never voluntarily inject themselves with a needle. "You can get it from having sex with somebody who has HIV if you aren't using a condom. That's if you are a girl or a boy, it doesn't matter. If you get stuck with a needle or come in close contact with like blood or something. But not spit or saliva."

"For real?"

"For real. Like there's a lot of happy couples that kiss and make love and everything where one person is HIV positive and the other one is negative. And they stay that way. Kissing is fine. Even really, really kissing--as long as the person doesn't have like an open bleeding sore or something. It would take a lot to get HIV through the mouth. Now a cold? You can get a cold. Did Justin have a cold?"

"No, ma'am. He stay healthy."

"That's great."

"I had made my baby an appointment. I was gon' see if they could test her for the AIDS."

"Nika, cancel that appointment. I would use that time to go and find Justin and tell him you're sorry and that you didn't know. Tell him you didn't mean to hurt his feelings. You know? Because you probably did, you know. . .hurt his feelings."

She looked down. And finally she had stopped shaking.

"Nika?" She raised her eyebrows. "I wanted to mention something Justin said. So if you come in contact with the virus that causes AIDS, and it gets in your body, that's called HIV positive. HIV can hurt the blood cells that fight infections and then when they get low, you are prone to getting sick. There's a lot of medicines that keep people from that point, and doctors who help them. But if the blood cells get low, that's called AIDS. And it's okay to just refer to what Justin has as HIV, if you must, instead of 'the AIDS' or 'the HIV.' That's if you must."

"He prob'ly was hurt. He lookeded real hurt," she said in a tiny voice.

"Well, it sounds like he trusts you with a lot of personal information. I'm pretty sure he'd be cool if you told him about our conversation. I say the wrong thing all the time when I don't know that much about something. If you are really sorry in your heart, then somebody who loves you will accept your apology."

She gave me a bright smile, and for the first time, I noticed the gleaming gold tooth on the side of her mouth. "I sure 'preciate you for taking the time to talk to me. For real."

"I just wish I'd seen you two weeks ago," I replied with a wink.

"So cancel the appointment?" she confirmed before leaving.

"Yep. Cancel the appointment, but not the friendship."

She nodded slowly and pointed in my direction. "Right. . ."

And just like that she departed and headed for the elevator. But not before I heard the beginning of the call she placed on her cell phone. . . .

"Hey, J. . . .wha's up? It's me. . . ."

All in three minutes. Wow.

I went back to finishing my notes and made it to daycare with time to spare.

Home plate.

home plate

Yesterday on rounds at Grady:

Grady elder:  "I need you to herry up and discharge me."

Me:  "Well, I just need to make sure you won't need oxygen first. I hope that's okay."

Grady elder:  "How long tha's gon' take?"

Me:  "Not too long. Why the big hurry, sir?"

Grady elder:  "Cawse my wife made some ribs and I don't want 'em to be all gone by the time I get home, tha's why.

Me:  "Must be some good ribs."

Grady elder:  "Sho' is."

Me:  "I bet your wife saved you a plate.  I bet."

Grady elder:  "Yeah, she probably did."

Smile

Me:  "How long have you been married, sir?"

Grady elder:  "Whooooo. . . shoooooot. . . .well my son is fifty-nine. . . so. . .at least that long."

Me:  "Wow."

Grady elder: "Yep. We been together a long time!"

Me:  "What's the key to being married for that long?"

Grady elder:  (laughs) "Jest get out each other face when you get mad and put up with each other's junk."

Me:  (chuckling) "That's it?"

Grady elder:  "Well, 'course you gots to love each other. 'Cawse ain't no way you could do it if'n it ain't no love. But me--when I gets mad, I jest go fishing."

Me:  "Fishing?"

Grady elder: "Yes ma'am! All day long. Then I comes back with some fish for my wife and she gut 'em and clean 'em and cook 'em."

Me:  "And that makes her happy?"  (Because I'm pretty sure it wouldn't make me happy.)

Grady elder:  "Shooot, yeah. By the time we eatin' that fried fish we done forgot what we was mad about." Threw his head back and laughed.

Me:  (chuckling) "I love it!"

Grady elder:  "You married?"

Me:  "Yes, sir."

Grady elder:  "How long you been married?"

Me:  "Almost seven years, sir."

Grady elder:  "Seven years? Awwww, shoot! You jest gettin' started. You ain't even made it to first base yet!"

Me:  "No?"

Grady elder:  "Naaawww."

Me:  "Not even first base?  Where am I then?"

Grady elder:  "You jest steppin' off the home plate."

Me:  "Dang!  When do you get to first base?"

Grady elder:  "Not 'til ten . . twelve years."

Me:  "And where are you?"

Grady elder: "Shooot, I done made it round three, four times.  And now we gettin' ready to slide into home plate."


***

home plate

Getting home to get his home plate while sliding into home plate.  Does it get any better than that?

::sigh::

I. Love. This. Place.

Old School meets New School.

*Warning: Completely nonmedically related and totally random post ahead.
_______________________________________________

"I hope and pray that I will, but today I am still just a bill. . ."

____________________________________

The Manning household believes in giving our kids a sho' nuff taste of the old school. Here's what we have been doing over here with our Sunday evening since finishing dinner and bathtime. . .

Whaaaaat???? What y'all know about that?

Oh yeah, baby. . . . thanks to YouTube, we've been rocking out to some classic School House Rock.


Real quick for the thirty-somethings and up--am I the only one who learned the preamble to the Constitution, the difference between a bill and a law, and all my parts of speech from these infectious little jingles? Tell me you didn't recite the preamble in a high school Civics class while pretending like you weren't singing the words to this:



You know you did. If you didn't, you are
a) not old school at all
b) somebody who grew up without a television on in your house on Saturday mornings,
c) not from this country, or
d) all of the above.

Awww. Is that you?

Okay, then let me school house rock you. This is how the Saturday ritual went down back in the day at least in my neighborhood:

• Every Saturday you woke up waaaay before your parents.
• You stumbled into the kitchen and poured yourself a giant bowl of Trix, Frankenberry, Cocoa Puffs, Sugar Corn Pops, Honeycomb, Frosted Flakes, Cap'n Crunch, or Apple Jacks.
• If your mama was on that "no sugar" kick (like ours periodically was) you instead poured a bowl of Rice Krispies or Kellogg's Corn Flakes OR-- as Harry just told me to add--that generic black and white box of just "Corn Flakes"--followed by ten heaping tablespoons of sugar that your mama had no idea you'd be slurping from the bottom of the bowl later. (Sorry, Mom.)
• You carefully carried that big-a bowl into the den, sat it on the coffee table, and then turned on the TV. (Remember when it had to warm up first?)
• Because there was only one channel with cartoons playing, even if you had several siblings, nobody ever argued over what to watch.
• Once the TV was on, you'd go back to grab the big-a bowl of now soggy cereal and sit criss cross applesauce on the floor.
• You watched cartoons from 8 AM to noon--moving only for the bathroom and to top off your cereal, after which, cartoons promptly were replaced by made for TV movies or sports.
• You did your chores.
• Your mama told you to go outside to play. For the day.
• You came back when the street lights came on.
• Oh, one caveat: If you played sports on Saturdays, you went to your game after cartoons.
• Then, when you got back, your mama told you to go outside and play. For the day.
• And you still came back when the street lights came on after riding your bike God knows where without a helmet and with a younger sibling holding onto the back of the banana seat and a next door neighbor riding on the tasseled handle bars.

Insert six year old on back (turned backwards), insert seven year old me riding, insert seven year old on handle bars.

Yeah, man. Four hours of cartoons pretty much on Saturday only and that was it. This is pre-PBSkids, pre-Disney Channel. . . .pre-cable! I'm talking bunny ears on top of the TV that sat on top of the other TV that was broken. (Y'all don't know nothin' bout the old school, man!)

But I'm sayin'. . . the Manning boys? Oh, they will know old school when the see it.

Starting with School House Rock. Here's our three favorites:







And I'm sayin' -- Zachary Manning? Oh he WILL bust out in song with any one of the above jams completely unsolicited. Especially "Interjections." Public places included. (I always feel proud when folks look at him all impressed-like at his knowledge of such old school cartoon classics.)

::smile::

Unfamiliar with the old school? That's okay. Get familiar--starting with School House Rock. And if you haven't already. . . get your kids familiar, too. (I'm just sayin'.)

The noun song. . . .


. . .but sayin' all those nouns over and over can really wear you down. . .


Zachary and I always hug each other at the end of this one. . . .



Darn! That's the end!

(Consider yourself School House Rocked.)

Heavy.

"So on we go
His welfare is my concern
No burden is he to bear
We'll get there
For I know he will not encumber me
He ain't heavy, he's my brother"

~ Donny Hathaway

Today I am thinking about trust. I am thinking about how although folks often talk about how little some people trust their doctors-- that there are a lot of folks that put a whole, whole bunch of trust in their doctors. And not just any kind of trust, but that save your life kind of trust.  Like, I know you've got my back no matter what kind of trust.

Compound that with being a black woman on the front lines of a county hospital and it gets even more complex. Like, you get me so you know deep down what I'm afraid of kind of trust. Like, I know you wouldn't let nothing happen to me on your watch kind of trust. 'Cause you get me. 'Cause I'm your auntie and your uncle and your sister and your granddaddy. 'Cause I'm your mama'nem and your Mudear and your play cousin. And sometimes, it's heavy.  Real heavy.

'Cause even though they are thinking those things, they aren't alone. I am, too.  I am thinking, you can trust me. I am touching your hand and using your language in a way that says, I do get you and I do know what you are afraid of deep down. And even though sometimes it's unrealistic, I am feeling, no, I won't let nothing happen to you on my watch. Even if it's out of my control.

So I pray. A lot. To fill in the gaps that reading journals and calling consults can't cover.

And today? After all of that, I stood in a bathroom stall and cried. Because a lot of times it is out of my control. And sometimes things do happen. Even on my watch. And today, it was heavy.  Real heavy.

So thankful I'm being carried, too.

***

"If I'm laden at all
I'm laden with sadness
That everyone's heart
Is not filled with gladness
Of love for one another. . ."

Dad, do you remember when you played this Donny Hathaway song for me when you drove me to medical school across the country? I know you don't. But I do. Especially today, I do. . . . playing on my mental iPod. . . listen and you'll feel me.

 

Thursday Top Ten: "Week on the Wards"

These boots were made for walking.

My friend Lesley M. told me yesterday that she loves reading my blog when I am on the inpatient service. Although the clinic has scored me some excellent blogworthy material, I'd have to side with Lesley on the abundance of experiences during ward months that make me want to run to my laptop.

And so.

With that in mind, I bring you this week's Thursday Top Ten: The top ten things I heard and/or saw at Grady Hospital this week on wards.

Oh yeah.

This reminds me--in the first week of the medical school curriculum, we have this thing called "Week on the Wards" for the first year students. I like it because it's a great baptism by fire for folks who may need to recognize that they have no desire to be baptized. Vomit on shoes, rounds that last a wee bit too long, rashes that give you the willies, and teeth so riddled with decay that you immediately schedule an appointment with your dental hygienist upon leaving---yes, my friends! All awaiting the youngsters who step their shiny shoes onto the wards for that first week. Now the good news, as always, is that all of those things get overshadowed by the human beings. . . . the wonderful human beings. . . whose hands you touch, whose life stories you learn, and whose lessons you internalize that leave you forever changed---even after a simple week. It leaves you saying, "I want to be a doctor."

As an M-1 student (first year of med school), you can't help but reflect on what you've seen and heard. But as an M-19 student, it gets a little harder. You have to remind yourself to marvel at and smile at what threatens to become mundane. So I guess I'm just trying to still hold onto the wonder of being new at this, and in a way, make every week a "Week on the Wards" experience.



Top Ten Things I Saw or Heard at Grady Hospital This Week:



#10 -- Consultation.

Man sees me in the hall at Grady.

"'Scuse me, don't you be on Fox 5?"

"Yes sir."

"Oh okay, then. Can you tell me what you think this is?" Lifts up shirt and shows me the side of his left flank which has what looks like an abscess.

"Uhhhh, does that thing hurt?"

"Yeah, ma'am. It do hurt real bad."

"Uhhhh, did you hurt yourself there or injure yourself?"

"I shot my insulin there, but tha's it."

"Hmmm."

"You could touch it, I don't mind."

"Uuuuh, yeah. Um, that's okay." I pause for a minute and decide how roped in I want to get. "Um, so that looks like a pus pocket and you need to get it drained and packed. If you don't you could get pretty sick. I think you should go to the emergency department."

"Yeah, tha's where I was headed, but then I seen you and said, 'Tha's that lady that be on Fox 5, so let me see what she talkin' 'bout.' So, now I'm fixin' to go over there to get it drained out."

"See?" I responded,"You didn't even need me. We was talkin' 'bout the same thing all along." I smiled.

"Sho' was, wasn't we?"



#9 -- Hair today, gone tomorrow.

A patient on her fourth hospital day said to me, "You know what I need? Some tweezers. I'm 'bout to have a goatee up in here if somebody don't get me some damn tweezers!"

Okay, so can I acknowledge that nearly every woman has at least one unruly hair that grows somewhere on her face that, although it does not lead to full on goatee status, if left untamed and unplucked could become something of great concern?

I know someone who shall remain nameless that made me promise that if she were ever in a hospital or otherwise infirmed and could not get to those wiry hairs that I would take it upon myself to take care of it. It's kind of like being a goatee godmother. Ladies: If you don't have a goatee godmother, get one. (I'm just sayin'.)

#8 -- Baby love.

A lady in the elevator had a baby that was so cute that it made my ovaries hurt. (Don't worry--only for 2.2 seconds, which isn't long enough to be dangerous.)

"That baby is beautiful. And look how happy he is!"

"He look like he want to go to you." And just like that she handed her beautiful little baby to me. Like she instinctively knew that I wanted to hold him. (I so did.)

I cuddled him all the way to my floor. I love Grady.

#7 -- Diet shmiet.

In the cafeteria:

Cafe lady: "Ma'am have you ordered?"

Me: "I'll have a turkey burger, just the burger."

Cafe lady: "Turkey burger! Plain! No bun! Next in line!"

Other lady: "Yes, I'll have a chicken breast. Just the chicken." Looks over at me and smiles.

Me: "Bread is the devil." We both laugh.

Other lady: "Yeah, chile. Tryin' to stay in these clothes." We both smile. I chastise myself for thinking that her treacherously tight clothing is already one biscuit over being stayed in. Smack my own hand. Shame on me for thinking that! Decide to think, Good for her for making a smart food choice because she did and she should totally get credit for that.

I smile at her again and nod.

Cafe lady: "Here's your turkey burger--you want any sides?"

Me: "No, ma'am. I'm good."

Cafe lady: "Chicken breast--sides, baby?"

Other lady: "Yeah, let me get some of them potato wedges you just dropped." Wait, huh? As in dropped in the grease to be deep fried.

Um, yeah.

Me: I know how I have a tendency to be all up in grown folks' diets. I immediately ask myself, WWHS -- What would Harry say? This is how I (sometimes) keep my big mouth from getting me into trouble: That's a grown woman and those potato wedges are none of your business. None of your business. Put a lid on it. Stay in your own lane, Manning. (Biting tongue until it nearly oozes blood.)

Other lady: "Alright then, girl. By the way, you be doin' good on channel 5."

Me: (tongue swelling due to intense biting as I watch her walk away with plateful of greasy mojo potatoes.) "Thanths."

#6 -- Boo who?

One of my patients took it upon himself to address me as "boo" for his entire hospitalization.

Sunday:

"Hey sir! It's Dr. Manning!"

"What's up, boo?"

Monday:

"Are you in any pain?"

"Naw, boo, but help me get these bowels moving, would you?"

Tuesday:

"Hey, boo, I like your outfit!"

Wednesday:

"Hey, boo--you'll do me a favor and see what time I last got my pain medicine?"

(Is it bad that I thought it was endearing?)

#5 - Weak on the wards.

I supervised one of the medical students as she attempted to perform a lumbar puncture on one of our patients. She wasn't successful even though her technique was perfect.

I wasn't either. A different doctor would need to do it.

The patient was fortunately gracious, and wasn't in much pain. I think it was a good reminder that just because you are an M-19 doesn't mean that you succeed at everything.

#4 - Hold it.

In the hallway:

"Hey, doc, can I hold five dollars right quick?"

"Hold five dollars?"

"Yeah. I'll give it back to you, I promise."

"Umm, I've never seen you before. Like, in my life, I haven't."

"But I'm for real, I'll pay you back."

"Uhhh, yeah. I'm gonna have to pass on that one."


#3 -- Be still my blogging heart.

Sitting at the nurses station:

Girl in a Georgia Tech sweatshirt approaches me.

"Excuse me, are you Dr. Manning?"

"Um, yes. . . . errr. . . yeah, I'm her."

Now smiling with big smile. "OMG, really? How fun. I read your blog, and I just love it."

Me, now smiling with bigger, goofier smile. "Rrrrreallly?" Ting.


"Totally! You're a total trip!" Walks off.

Hmmmm.

#2 -- Shout outs.

Had on my favorite green rain boots on Wednesday and a patient called out to me as I gleefully kicked puddles while crossing the street:

"What's up, Bootsy Collins!"

(If you know who Bootsy Collins is, you, too, would find this amusing.)

#1 -- Feed the chil'ren.

One of our octogenarian patients was accompanied 24 - 7 by her sixty-something year-old daughter for the whole hospitalization. This daughter was a grandmother and even a great-greatgrandmother two times over. She adopted everyone on the floor for the whole time her mom was hospitalized.

The other day I was rounding on her mom and was wrapping up the visit by chatting with them about our plan. In the middle of the conversation, two thirteen year old girls come in and hand her some money.

"Did y'all get what y'all wanted?"

"Yes, ma'am," they answered in unison.

"Did you get a drank, too? What you get?"

"I got the filet o' fish meal and she got the quarter pounder meal. And a apple pie."

"Good. Alright then, baby."

"Thank you."

The two girls walk off and go to sit next to the OTHER bed in the room with ANOTHER patient. I was totally puzzled.

"Are they related to y'all?" I asked.

"Oh, naaah. They with her." She gestured to the neighboring patient. I looked confused again so she clarified it for me. "Them chil'ren been here all morning and I axed 'em what they eat for breakfast. They ain't ate no breakfast. Then I axed 'em what they ate for lunch and they ain't ate n'an. I axed 'em why, and the chil'ren didn't have no money."

"So you gave them money to get something to eat? And you don't know them?"

"You can't let the chil'ren go hungry, baby."

"Wow."

"I don't have much. But what I has I give. And it seem like the Lord manage to provide for me long as I do stuff like that."

::sigh::

I love Grady.

Falcons fan and caring human being:
Taken and shared with her permission (from right after that moment. :)

***

Happy Thursday.

The woman in the elevator.

Yesterday I ran into that woman that I'd met in the elevator last year who worked in the cafeteria. She was the one who had taken it upon herself to bring a patient a special meal and two pieces of cake--because she had noticed on the patient's ID band that that particular day was her birthday.

It was quite a moment.

The funny thing is that I never asked her name that first day and I wished that I had. I loved how much pride she obviously took in her work. It actually made me want to do better. I kept thinking. . . anyone who would be kind enough to do such a thing (when no one was watching) just seemed like the kind of human being I wanted to know by name. And you know what? I wasn't alone. At least three other people at Grady Hospital asked me if I knew her name. Everyone, it seems, wanted to know exactly who this nice person was.

And so I finally had my chance to end the mystery. I asked her, "Do you remember me from that day that you let me take your picture in the elevator? I asked if I could write about you? I did write that story about you, but never got your name."

She looked at me with wide, surprised eyes from around the giant metal food cart. Kind of like, Who me? Which immediately made me feel a tiny bit ashamed that maybe people in long white coats usually aren't talking to her or even noticing her on elevators, even when accompanied by a six by six foot box of stainless steel on wheels. "I do remember," she answered. "I do."

"That . . .what you did. . .was one of the best things I have ever seen. Seeing you that day made me want to find ways to make my ordinary actions more extraordinary. I know that woman was so blessed by you that day."

"She was a prisoner. I know that it ain't my business why someone in a situation, but it was her birthday and she was a prisoner. She didn't have anybody to see her or make her smile or nothing."

I imagined this patient with her ankle shackled to the end of the bed--unfortunately not an unusual sighting in a public hospital. I thought about how easy it is to pass judgment on such a person, and how helping somebody on lockdown celebrate their birthday is generally not at the top of most people's to do list.

"What is your name?"

"Regina," she replied. She flipped over her work badge so that I could see it. "Regina L."

The elevator doors swung open on the tenth floor--my floor--but I let them close. Regina reached out to hold the door for me, but I waved my hand to tell her I would stay on and ride with her. I needed to tell her what I hadn't told her before. And I needed to tell her by name.

"Well, Miss Regina, you are something special. What you did that day was really remarkable.  I've thought of you often since that day and I'm so happy to meet you. I just wanted to tell you that."

"I 'preciate that, ma'am. I really do." She placed her hand on her chest and softened her eyes and voice.

"No, I appreciate you."

"It ain't every day you hear somebody say that to you. I don't even know what to say."

The lift had climbed up to the twelfth floor and had returned to ten again. Miraculously, no one else had joined us on the entire ride. I knew my team was waiting for me to start rounds and that I needed to go. I thought about my friend Crystal C., and something she once said to me:

"There is power in touch."

So I decided to touch Regina. To physically touch her. Before stepping out of the cabin, I reached out and grabbed her thin hand and squeezed it tight. "I'm so glad I saw you again, Regina. My name is Dr. Kimberly Manning, and I'm so honored to know you. Really." I covered the top of her hand with my other hand and held it for a moment.

She stood next to the enormous rolling box smiling as the doors swallowed her up and carried her off to the next floor. Just like that.

A name to go with the face.

Yeah, man.

Crystal was right. There is power in touch. Just like that first day when I met Regina. And just like that moment last year when she took it upon herself to bless someone for no reason.

Today, I think I'm going to do my best to channel my inner Regina. Maybe you can, too.

Extraordinary Grady.

Gram stains and growing pains.

gram negative rods

gram positive cocci in cluster

 ________________________________________

"All I wanna do

is have some fun

I got a feelin'

I'm not the only one. . ."

~ from Sheryl Crow's "All I Wanna Do"

 ______________________________________

"Are you enjoying yourself?"

"Am I? I'm loving it, Dr. Manning! This is so much better than the classroom. I am loving every minute."

This was the exchange that took place between Joelle, the newly minted clinical medicine student rotating on my team, and me this morning as we trudged up the stairs to go and see a patient. The entire team had just rounded on all of our new admissions from the night before, and Joelle stuck with me for my rounds on the rest of our  service of patients. I loved her answer to that question. It was so genuinely enthusiastic.

"That's wonderful," I responded.  "It's something to love, Joelle. It really is. Enjoy your patients as people. That way you'll continue to love every minute even when you've been doing it for a while."

She looked at me and smiled a big smile.  She was loving it.

In that moment, I thought about my very first clinical rotation.  Like Joelle, I too started on inpatient Internal Medicine fresh off the M2 truck carrying a stethoscope without any scratches anywhere and a short white coat free of so much as even a trace of ring around the collar.  And just like her, I was thrilled at the idea of finally getting to take care of real, live patients on a daily basis in the hospital.

Those first few days were rocky for me. I started out at the VA hospital, and felt swallowed up by it.  I remember standing on the wards listening to rounds and hearing the words flying over my head and whirring past my ears.

DNR, DNI, AMA.

"Excuse me. . . .uhhh. . what does 'DNI' mean?"

"Do not intubate. So like I was saying, this guy has terrible COPD and smokes like a chimney. He was demanding pain meds and got mad when I said no.  He wants to leave AMA." The resident spoke directly toward the attending with virtually zero interest in us medical students hearing, let alone getting what he was talking about.

"Pardon--what is AMA?"

The resident did little to hide his scowl at yet another question. "I'll go over some stuff with you guys after rounds," he replied.  This was his way of telling me to shut my piehole until they finished rounding.  It was one of the last questions I would ask that month.

We never did get around to that teaching session.

The following month was at another hospital. I remember being the student on a team with one intern and one resident. Back then, the lab closed at eight p.m. so any special things you needed overnight fell on the doctors. In our case, it fell on the medical student.

"Take this sputum upstairs and make a gram stain of it, okay?"

I remember raking through my terrified brain for some kind of remote idea of the steps involved in a gram stain. Gram stains tell critical information about the type of bacteria causing certain infections. The whole thing involves multiple steps which yield either germs that hold on to this particular stain (gram positive) or ones that don't (gram negative.)  The kind of antibiotic regimen, the urgency, and all of the management in many serious infections rides heavily on this piece of information which, for reasons that will forever escape me, the resident deemed me the appropriate person to obtain.

Um, yeah.

I recalled the times in our second year Microbiology lab where we'd done the gram staining process. Every single time I'd performed it, I'd done something wrong which always left a little too much stain on the slide.  And so. With me as the technician, everything was "gram positive."

Gulp.

I decided to come clean with my trusting/lazy resident.  "I'm not sure I am so good at the gram stain. Can someone help me?"

"No because we'll be doing a lumbar puncture on that other guy we just admitted."

I'd never seen a lumbar puncture.  I had read about them, yes. But had never seen one in real life. "Can I watch you guys do the LP first?"

Bubble expanding. . . .

"No because we need that sputum result."

Pop!

The resident didn't even look like he needed to think about it. Clearly my experience as a bright-eyed, bushy-tailed fresh off the boat clinical medical student meant zero, zip and nada to him. This was a done deal.  "Oh yeah," he added without even looking at me, "and take this urine, too. It's for that lady with pyelonephritis we just got. Spin it and gram stain it while you're up there." He held up a capped cup filled with a scarily cloudy appearing tea-colored urine specimen.  Great.

So I remember fumbling around in that lab praying that my very bootleg gram stain technique would not lead to some poor unfortunate soul receiving the wrong antibiotic. I panicked, thinking about how much scarier a gram positive rod is versus a gram negative one, depending upon the specimen. For a split second, I thought about throwing out all of the specimens, getting into my car, and driving west until I reached my Momma and Daddy's doorstep at home. I decided against that, considering there were sick patients involved.

I stained the sputum first. Gram positive.

Oh Lawd. 

Next came the urine. I spun it in the centrifuge, nearly catapulting across the room at first when I didn't close the top on the machine. Whoops.  I stood there praying that I would get it right while making the slide. I wasn't grown up praying--I was praying in that eight-year-old way you pray when you release a bowling ball into the lane and it's headed for the gutter.

Please Lord don't be a gutter ball. Please Lord don't be a gutter ball.

I felt like my bootleg gram stain was headed in a similar direction. Please, please, please. . . .gasp. . . is that. . .gram negative?  I am pretty sure I did the happy dance once I confirmed under the microscope that it was indeed gram negative rods---the typical and expected bacteria of a young woman with a urinary tract infection.

Hallelujah.

I made it back just in time to get handed a specimen bag full of spinal fluid. "Go spin this and stain it."

Nice.

This is what they call getting "scutted." I pretty much got scutted for the majority of that month. The good part of it is that me and a few of my classmates got pretty proficient at random laboratory procedures. The bad part is that I missed out on some high yield things, mostly because I was being sent off on scavenger hunts during all of the action. Even still, I can appreciate the experiential learning that I had while doing all of it. I guess.

But.

The worse parts of both of these months were my interactions with my attending physicians. I was pretty much invisible. And seeing as I have never been invisible anywhere, this was a hard pill to swallow. I will never forget the day that, after like ten whole days of being on the service and rounding with the team, my attending said, "Hello, are you going to be one of the student doctors here with us? What's you're name?"

"Kimberly Draper," I answered quietly, "and actually, I've been here for just about two weeks."

You know, the one that's been spinning down pee and staining up your patients' hocked up loogies all night on every call?! You know, the one that manually evacuated the horrifically constipated bowels of that ninety-nine year old woman two days ago-- upon your request?  You know, the one that introduced herself to you four times already this month?!? 

"Oh okay, then. Nice to meet you, Kimberly."  

Jerk.

From that moment forward, I made a vow. When I grow up, I will never, ever ignore the medical students. Ever. I will never not know who I am working with. I will never allow any hardworking human being on my team--be they a medical student, pharmacy student, pharmacy resident, Physican Assistant student, or visiting student--feel as invisible as I felt over those two months.  Ever.

Fortunately, I had some great role models on my other rotations who paid (sometimes too much) attention to us medical students. But I still will never forget that first rotation and how it made me feel about Internal Medicine.  I pretty much decided that I hated Internal Medicine based upon this experience, only to learn from one of my surgical attendings that "liking the patients on the wards but not the OR isn't really consistent with being a surgeon. That's called Internal Medicine, sweetie."

Ah hah.

I suppose being looked through or not important enough to be memorable after four separate introductions had left me feeling as washed out as those gram negative rods. As much as I'd wanted to hold onto some positive aspect of the experience, all I was left with was a faded version of it any time I looked under the microscope. Which sucked.

Yeah.

So for this reason, poor Joelle and countless other medical students on ward teams past and present  have been schlepped all over the hospital and up more flights of stairs with me than can be quantified. . . . .here, there, everywhere. Seeing patients. Listening to heart murmurs. Discussing hard diagnoses. Holding peoples' hands. And a few times, even looking at gram stains in the lab. But without fail, whenever we do that, we talk. About non medical things and fears and feelings. I try my hardest to find out the things I wish my attending had asked me back then. Like. . . .

"Where are you from?"
"What's your favorite food?"
"What are your hobbies?"
"Do you speak any other languages?"
"Where have you traveled?"
"What kind of talents to you have?"
"What are your mom and dad like?"
"Wow! You did a half-iron man?"


And stuff like that.


But I especially ask this one. . . .

"Are you enjoying yourself?"

Because now that I think of it. . . on many days when I'm teaching + learning + caring for patients at Grady. . . .all I wanna do is have some fun. And you know what? I've got a feeling I'm not the only one.

Olivier, a former student at commencement (with his parents) -- More than a gram-stainer, indeed.