Last night on the way home from an impromptu playdate with our good friends, The Nankervis/Esler Clan:
Isaiah: "That was fun, hanging out with Cassidy in the storm."
Zachary: "Fiona, too!"
Isaiah: "You were playing with Fiona. We're six so we were doing big kid things."
Me: "Hey guys. . . wasn't it funny that there was ice coming from the sky even in the summer?"
Isaiah: "Mom, are you talking about the hail storm?"
Me: (in my head) Yeah, wise ass.
Isaiah: "Boiled peanuts?"
Cassidy: "Yep. Boiled peanuts!"
Isaiah: "Tastes kind of unusual."
Cassidy: "To me, they're yummy!"
Isaiah: "Hey! The shells might make good boats for the river next to the cars!"
Cassidy: "Good idea!"
Me: "You and Cassidy and Zachary and Fiona are old friends."
Isaiah: "No, we are not old!"
Me: "Not you are old. But you've known each other for a long time. Like you and Cass met when you were only one. And Fi and Zach were only a few weeks old."
Isaiah: "I was only one?"
Me: "Yep. You hadn't even turned two yet!"
Zachary: "But no, Mommy. You and Fiona's mommy and daddy are old friends because you have to be old. But me and Fiona, we did used to be baby friends."
Me: "Baby friends, huh?"
Zachary: "Mommy?"
Me: "Yes?"
Zachary: "Now, I think we are in each other's family."
Me: "I like that. Old friends are like family."
Isaiah: "Wait--are you sure I was only one when I met Cassidy? I don't remember that. . . . I really don't."
In and out of screen doors. . . hail storms. . . laughter. . .Popsicles.. . .watermelon. . .mosquitoes . . .kids. . . life. . . .
. . . and witnessing all of the magic on a big covered porch with old old friends, young old friends, formerly baby friends. . . .and, of course, family. . . . .
*sigh*
This, my friends, is summer in the southern United States.
Okay, y'all. I have a confession. Well, maybe not a confession technically. . . but more of a declaration. . . .yeah, a declaration.
I want to be a runner.
Yes, people. A runner. As in a "Hon, I'm going out for a run to clear my head" kind of runner. As in the person who wakes up on a vacation and says "Who wants to go for a run?" kind of runner. But--as of June 14, 2011--I am not anything even close.
There. I said it.
Hold up--now, let's be clear on something--I am fairly fit and I do work out. I weight train (when I can) and can roll with the best of 'em in even the most choreographically hell-atious step aerobics classes. (Yes, I'm one of those obnoxious ones that yells out "Wooooohhh!!!" when the teacher does a 32 count combination only once and then asks, "Y'all got that?") I've survived boot camp experiences, 11 grueling days of the P90X and even that creepy Tae Bo kickboxing craze. But running? Sigh. It's the final frontier for me.
Sure, I can run. But I can't run-run. See, the problem with me and run-running is that never have I ever reached that nirvana place with running where:
a.) It feels good.
b.) I feel this alleged "high" that my former Grady doctor friends, Julie E. and Julie J-M., are always talking about.
c.) (and most important) I am not constantly thinking about the fact that I am running, how long I have been running, and when I will get to stop running.
The Crazy Running Julies (on their runner's highs.)
Dr. Julie J-M--This morning after running. Doesn't she look happy?
Dr. Julie E. right after running a marathon, and yes that is her infant and toddler. Grrr.
See what I'm up against? This is what I am faced with in the workplace. I'm just sayin'!
Then there's the home front. . . .man. Like, I see these people of every conceivable age running all through my neighborhood 24-7. I cannot pull out of my driveway without almost mowing down someone jogging behind their family Labrador retriever. Some of them are in their own little iPod worlds. A few hard core ones are just one with the wind and completely void of electronics. Then there's those folks I see running together while holding full on conversations, complete with hand gestures.
What the. . . . ?
Let me just tell you from my own experience--it's impossible to gossip while concentrating on the fact that you are running. Especially when you've been running for less than a mile yet it feels like a marathon and you're busy calculating how many more steps you must take before being respectable and not a quitter.
Now. I am sure that some of my favorite keep-it-real people (like Ms. Moon, for example) are reading this and thinking, "Uuuuh, so how 'bout NOT running then since you hate it?" To which I quickly rebut with what I heard way too many times as a child:
"That would be too much like right."
Seriously. . . the thing is. . .I realize how crazy this quasi-obsession with running sounds. But as of late I just can't give it up. I'm convinced that I've yet to get over some invisible hump that will surely lead me to the Flo-Jo promised land. Surely.
Next confession: Yes, I want a healthy heart and the joy of beating my chest in triumph at the end of achieving my goal of running anything longer than three miles. But. There is another reason that I must come clean about.
Hotness.
Now check it--I've been keeping a gym membership and going to gyms since my early twenties. So trust me, I have some working-out perspective. In all those years, I've been conducting a little observational study with unmistakable and unshakable results. Yes, people. The numbers are in.
Without further delay, I bring you the statistically significant findings from my fifteen year longitudinal observation of human beings in gyms, parks, and other public places associated with working out:
Hotness = Running.
Wait--before you say, "Whaaaat?" let me explain.
In every single class I have ever done, there are always a couple of women there that are at the exact level of fitness that I aspire to attain. Yes, there are those scary buff chicks that look like they haven't eaten a carbohydrate in the last ten years with muscles in their faces and such--but I am NOT talking about them. I'm talking about the ones who run out ten minutes early to get their kids from the gym playcenter like me and the ones that see me on soccer fields and say, "Don't I know you from the Y?" Those women. Them.
And so, like always, I ask. "What else do you do besides (fill in the blank) class?"
Without fail, the answer is either in the form of the half-marathon t-shirt they are wearing or a simple shrug and this answer:
"Other than Body Pump, I just run a few miles a few times per week. That's all I have time for."
Ah haah!!
Today I walked out of the gym behind this woman who had to be forty, but this was only apparent from the neck up. From the neck down? Chile please! She had the body-Oh Lawdy! She jumped in her car (with the "26.2" bumper sticker) and drove off.
Ah haaah!
Therefore, I maintain that the most fabulously fit people that I know and see all frickin' run. And they seem to run more than two point five miles. Before I get any push back, the quick exceptions are personal trainers and gym instructors who, by the nature of who they are, do all sorts of other equally heinous things to their bodies to keep them lean mean fighting machines. But that's not who I'm talking about. I'm talking about regular people. (Got that, fit-mama Claudine?!)
Oh, whoops. There was one other very important portion to my study that must be reported as well:
Hotness = Running.
BUT
Running DOES NOT = Hotness.
Confused? Don't be. Check it out. The people I see whose bodies are consistently fit and lean all seem to run. However. I see a whole bunch of folks running that are not anywhere close to fit and lean. Which kind of sucks.
Case in point:
Every year, the kids and I cheer as the participants in the Atlanta Marathon run right through our neighborhood. First we see the elite runners, next some other speedy-but-not-elite runners, and then comes the crowds of regular, yet respectable, runners. Some of them are exactly what I described--lean, fit, yet not overly scary-buff. But often times, right beside them, I see dudes trucking it on 8 mile minutes with spare tires that look like a twenty week pregnancy.
What's up with that?
Anyways. That's really all I've got today. I have this plan to run a half-marathon, which initially was just me talking until Harry said, "Uhhhh, you're going to what?" The moment he started hating on my pipe dream I got it in my head that I was going to be one of those women with the half marathon t-shirt come next year. Besides, my other motivation is that since (YES) I DO intend to get a mini-van at some point in the next year or so, I need to ramp up my hotness for all the folks who will see me stepping out of my mom-tacular swagger wagon and have no choice but to exclaim,
"Oh WOW! YOU'RE somebody's MOM???"
At which point I will pause for effect, point at myself and my washboard abs with a slow nod while flexing one of my guns--and THEN slowly saunter away with my hazards flashing in the carpool lane.
Yeah. That.
Oh and when you see me? Please, people. Don't hate. Congratulate.
***
Happy Tuesday.
Oh yeah. And speaking of congratulate--shout out to my blog-friend Andi at On Call RN for just completing her first marathon!
I was working on a lecture a few years back about crack cocaine and people's stories related to it. I met this gentleman who was dealing with a crack addiction in the Grady emergency department one day, and he was nice enough to let me interview him. "I want people to see the people and not just the addiction," I implored while doing my best to get his permission to tell his story to others.
"Knock yourself out," he replied with a confident smile. "Tell my story 'cause I'm not your average crackhead."*
(*note: I am not keen at all on the term "crackhead." I am using it in the context of this patient's words which are being shared with his permission.)
His story.
No, he wasn't your typical street drug addict. This man was a college graduate that had once held an excellent job with excellent benefits. Back then, his two kids were in private school, and he had a college-educated wife that he described as a "strong black woman" and "the shit" (in a good way.) This whole former life of his fit perfectly into a "four sides brick" and "built from the ground up" house complete with a terrace level and three car garage in an affluent Atlanta suburb .
He'd lost it all after getting "caught up" with crack three years before.
During the time of our interview, he was unstably housed between shelters, couch-crashing, rooming houses, and "lady friends." He was no longer in touch with his family and he described his ex-wife as "terrified of him." His parents were alive, but also "too shell-shocked to fool with him" and he was quick to let you know that he didn't blame them. "Crack is no joke," he said while shaking his head hard. "No joke."
He was handsome with a youngish face that couldn't have been more than forty five years old. He had a cropped mane of shiny prematurely gray curls with a mustache and eyebrows that had the exact same distribution of salt and pepper as that on his head. His teeth were surprisingly white, but the minute I looked at his hands I could see his story. Burns on his thumbs and finger tips. Fingernails with dirt so deeply lodged under them that they looked like some reverse version of a french manicure. Oh well, scary fingernails or not--he was charming for sure and even with the profanity, his buttery use of the English language was believably consistent with his report of graduating from "one of the best historically black colleges you've ever heard of."
Normally, I would have started asking things like, "What college?" or other random things to give myself a better idea of his other life. But this gentleman was sitting in the ER for reasons other than my interview and since he was both generous and loquacious about his personal truths I decided to get to the things I really wanted to know while the getting was good.
My main question was, How? How does an educated, successful, and good looking dude like you use crack cocaine even for the first time?
Sure, I've encountered countless fifty and sixty-somethings that were blindsided when someone took the ultra-pricey powder cocaine that they'd occasionally toot on holidays and birthdays, cooked it on a stove with baking soda, and made it go further by making it into "free base." The story is usually that they tried it way back when nobody knew how addictive it was. That was in the early and mid eighties, so their excuse was that they didn't know what hit them when they hit it.
There's also the younger people from horribly disadvantaged backgrounds that I've met who grew up seeing it so much that they became desensitized to it. Then, after existing in what was surely a living hell, decided to escape it on a five minute, five dollar rocket ship straight to the moon. Even if it meant ruining their life, depending on the day and the reality connected to it, just maybe there wasn't a whole lot to lose.
So, yes, I've seen those individuals and heard their stories and kind of got it how they ended up "caught up." And oft times, the majority of the people I meet who are under the stronghold of crack fall into those categories. But every now and then, I've met someone like this man--someone whose life I can very much identify with--which completely terrifies me.
So I asked him. How? How does someone like you even try crack for the first time? How does this happen? Is it like they say? Where you try it once and then from the very first second you are hooked? Like you spend your life chasing the first high? Is that true? But even if that is true, hadn't you heard that? Didn't you know better? How could this have happened to you? You are young enough to know that crack is bad news and old enough to have heard Mrs. Reagan wag her finger and tell you to "Just say no." How? How did this happen?
Yeah, it was a lot of questions. Thank goodness he was in the mood for questions since I was in the mood for answers.
"I was drinking and smoking weed one night," he recounted. "Vodka, tequila shots, all that. We were getting f--d up that night. It was me and a couple of my buddies. Smoking blunts, playing Spades, talking shit. You know how folks do when they getting it crunk." He chuckled. I kept listening, waiting for Act 2.
"So, then, my homeboy says, 'Man, you ever smoked a primo?' and I was like, 'What's that?' So anyways, he explain that this is like a blunt that has some cocaine in it. You know, and I was like, 'Cocaine? Aww, hell no!' I'm sayin' because I never had got nowhere near no cocaine. As for weed, I mean, sure we did that all in college and after, but cocaine? That was some other stuff."
"So you got hooked from the first time you tried it?"
"See, that's a myth, doc. That mess folks tell you where they say you hit the rock and next thing you know you're like a zombie?" He laughed out loud and this time rolled his eyes like the very suggestion was both naive and ridiculous. "Naaahh. That's not how it goes down. See, essentially, my man rolls this blunt with rocks in it. Seeing as I don't know nothing about cocaine, I don't even realize what is up."
"Why did you buddy even have crack? What was that about?"
"I'm sayin', doc. . .crack affects everyone differently. You know there's a whole, whole bunch of folks that go to work, go home, do their thing and use crack on the weekends. Some folks are just hardwired to be crackheads. Some can just do it on the humbug."
I nodded my head slowly, recalling this lady I'd encountered once who worked in the post office for twenty years but had used crack "once or twice a week" for the last ten. "So your dude was one of those people who used it on the humbug?"
"Yeah, he isn't really the type that's got the addict gene. But me? My family, we have that gene strong. We have all kinds of alcoholics folks with addictions in our family." I could relate to that part, too. "So yeah. . .my man rolls this primo and I'm f---d up already from the shots and I wasn't driving so I was like, 'F--k it, let's do it.' So we sitting around, like three or four of us, talking shit and hitting this blunt. And essentially, that was it."
"That was it? No ride to the moon or anything?"
"Nope. We even talked some shit about how we had all heard that crack rock makes you go crazy from the minute you hit it and all laughed about it. See, my man who rolled it and had it, after the fact, he was like, 'Y'all know that was rock' and we were all like, 'That was rock?'"
I sat there staring at him with my eyes squinted. I was waiting for the part where he lost his house, his wife, and his job. This sounded a lot less dramatic than what I'd imagined.
He went on. "You know what did happen, though?"
"What?" I quickly replied.
"The next day, I kept thinking about it. It was crazy. It was kind of like when you sneak off and have sex with a chick when you know you're married. Well, maybe not you, doc, but you know what I'm sayin'. You tell yourself you tripped and it was a one time thing but then you keep thinking about it. Like nonstop."
"Hmmm." I pressed my lips together and continued to let him have the floor.
"So after a while, I'm thinking about it so much that I think about casually asking my homeboy about it, but I don't want him thinking I am fiendin' for it or anything. . . .so. . .I say, 'F--k it, I'm just gonna get me some weed and roll through the hood and get a little five dollar rock to roll into my joint.'"
He went on to describe how his thoughts of his extramarital romp/drug habit became more and more frequent. He couldn't get it off of his mind, and once per week became twice per week. Twice per week became once per day. Once per day became without marijuana, and eventually in the end it was any chance he could with any pipe he could get his hands on.
"The whole time it was like watching a slow train wreck. It wasn't fast like people tell you. It was slow enough for me to say, 'What the f--k am I doing?! I can't believe I'm f--king doing this!' And the day I knew I was out there bad was when I withdrew the last $1500 from my savings account one Friday and had smoked it up by Sunday. It was so f--ked up."
Wow. This was so different than everything I'd ever heard about people getting mixed up with things like crack and methamphetamine. A slow train wreck? Wow.
"You look like you saw a ghost, doc!" he laughed. "Don't worry, I'm not contagious."
I stared at him and widened my eyes. "Honestly? Your story terrifies me because I have sons and they're no different than you. I mean. . .I'm no different than you. That--what you just told me--could have happened to anybody. Everybody's done something stupid at some point."
He rubbed his youthful face with his tell-tale hands and sighed hard. "You know, doc? All you have to do is make sure you talking to them about being careful with anything that messes with their thinking. Like, it's okay if they drink, but you might want to talk to them about getting pissy drunk." He narrowed his eyes and his face grew serious. "Doc, you have any addicts in your family?"
"Damn. Then talk to them about that, too. Tell them that it's not the same for them, so know that. Before they even get in high school, tell them. Hell, tell them all about me and what happened to me. Tell them I been to rehab and jail and still can't shake it."
Wow.
I sat there silently taking it all in. Finally I took a deep breath and spoke. "I will. I will tell them exactly what you said, I promise. As soon as they get old enough, I really will."
"Yeah, you should. I think if I hadn't been so drunk and if I had been afraid of drugs a little more I might've not even f--ked with it. Who knows? But yeah, if your mind gets twisted from something totally legal, don't think you can't get caught up on some illegal shit."
Real talk, man.
So that was that. That was how. That was what went down and that's how a super successful gentleman finds himself kneeling down in the corner of an abandoned building and having no idea how to reach a single member of his family.
So. . . what did I learn that day? A lot. I learned a whole lot.
*obligatory disclaimer: details changed to protect anonymity. . . . you know the deal by now, people!
Sweet dreams are made of this.
I was toodling about the wards one day tying up loose ends. It was late in the afternoon and the majority of the work had already been done. Patients had been rounded on and plans solidified. Teachable moments had been seized and F.P. designations established. I'd written all but two of my progress notes, and only needed to check a few test results before finalizing those. I looked up at the clock: 4:46 PM. Nice.
And so, I plopped down onto a chair on wheels and rolled myself over the computer with the keyboard that I like best (because clearly this makes a difference.) I sat on the vinyl padding like a thirteen year-old, left foot tucked underneath me and right leg tapping up and down rhythmically as I typed my notes. This was the less hustly-bustly side of that particular floor, further from the regular foot traffic, beeping nurse call buttons, and ambient noise. And at 4:46 PM, it was more peaceful than ever.
So there I was. . . in my groove. . . . fingertips dancing over those keys as I supplemented my thoughts to those of my interns. Eventually I found myself lost in my own world with this electronic medical record, so much so that I didn't even notice this woman standing on the other side of the nursing station.
"You doin' alright today?" she greeted me, startling me out of my foot-tapping and fingertip-dancing symphony.
I whipped my head over to the left and quickly fixated my eyes on her--kind of like that jerky way that the chipmunks and squirrels look at the kids and me when we're playing too close to them in our backyard.
"Yes, ma'am," I replied. "What about you?"
"I'm fine. They fixin' to discharge me, so that's good." She smiled a quiet smile, but something about her eyes didn't convince me that things were so good. I kept my hands still on the keyboard but my focus on her for a few seconds. Maybe I was reading too much into it. Like, maybe this was just a "you doin' alright today" and nothing else.
I couldn't place her age. I could tell that she was at least my age, though, but that was about it. The whole "black don't crack" adage was true in this instance; those clues of aging like crow's feet and neck folds weren't there to guide me. But there was still something mature about her coffee-colored complexion and a wisdom in her glistening hazel eyes that suggested experience and life. Now I'm thinking around ten or fifteen years my senior with all that wisdom she was giving off. Regardless of all that, she was striking.
"That's good that you get to go home," I announced with a cheery smile. She kept standing there, so I added, "Was there something I could help you out with?"
It was kind of weird, that moment. She gave me that same quiet smile and did this shoulder shrug coupled with a head shake. I wasn't sure what to make of it.
"Did you get a chance call your family to come pick you up? I bet they're happy you're getting out of here." I wanted to keep things light without getting all up in her business (like I have a tendency to do.) Instinctively I felt like something was wrong. Not in a medical way, but in some other kind of way. But this wasn't my business. She wasn't even a patient on my team, and the intricacies of her hospitalization or social situation were four lanes over from my lane.
"Oh. Yeah, I have someone coming to get me," she responded.
Someone? I didn't know what to make of that either, but what I did know is that she was standing there and I was sitting there and she wasn't moving. This didn't feel like an annoying hover, either. It felt like something else. . . . it was hard to describe. I decided to invite her in.
And so I reached into my pocket and pulled out my iPhone. "Can I show you something super cute? I have to show this to somebody," I said while scrolling through my phone. She walked toward me and reached for my phone over the counter. "This is my four year-old son singing. He's a trip!"
She watched the grainy video with genuine amusement. "Wow. . . he is something else!"
I took the phone back and smiled. "Do you have children?"
"I do but they all grown." She looked down and began twirling the ring on her left hand. I looked at the tiny pave diamonds on the band instead of at her because I felt like I'd struck a nerve. Then she added with a warmth in her eyes, "My kids are great. I've got some great kids."
The next thing I said flew out of my mouth before checking in with my brain's receptionist. "Is your husband living?"
What?! Is your husband living? Seriously, Kimberly?!
But, in my defense, I think what made me query the husband thing was the ring she kept flipping in circles with her thumb. I heard Harry like a tiny, drill sergeant angel flying over my shoulder yelling out, "STOP RIGHT THERE! GET BACK IN YOUR LANE!"
"Is my husband living? Hmmm. Yes. . . and no." She didn't seem to mind my question. In fact, she almost looked relieved that I'd gone there. "We not together any more. He decided he didn't want our life together, so he moved on. His life is another life that doesn't include being married to me."
"Dang. I'm sorry." I folded my hands into my lap and offered her what I hoped was a smile. My foot was now falling asleep under my bottom--turning numb like I'm sure she felt.
"Yeah. We was married for more than twenty years. Together even longer than that. But then we grew apart. My kids, they grown, but they was so hurt. . so mad. Even though they grown they was still so mad."
"How did you feel?" I wanted to know.
"How did I feel? I mean, at first I was real mad with everybody else and stuff, you know, 'cause he seem all happy to go on like it ain't nothing. But when I came in the hospital it felt different, you know what I mean? Like something about getting sick make you want the things you know. Even if they ain't the best for you. Now, I think I'm just kinda sad. "
"Yeah, being in a hospital makes you vulnerable for sure."
"Yeah. . . ." she leaned forward on the counter with the warm familiarity of a next door neighbor. "My leg was hurting and they fount a clot in my leg. They set me up with blood thinners-- all that, and the doctors said everything would be fine. But I felt so sad being in here without my husband. I haven't been in no hospital since my baby son was born and he almost twenty-five. It just seem like he should've been here with me."
Something went "pang" in my chest because I could dig what she was saying. My heart felt sad because it made such sense. Of course you'd want your partner of twenty-something years to be sitting next to you in a hospital. Of course you would.
"Do y'all talk to each other?" I asked. At this point, I was so far out of my lane that I flicked the Harry-sergeant-angel away from me.
"No, not really. I mean, my son, you know, he so mad. . .he called him up when we was in emergency. He said something like, 'Daddy, you dead wrong' and I told him don't say stuff like that and he got mad at me for defending his daddy. But my son, he so hurt. . .he so mad."
"What about you? Are you a little mad?"
"Like I said. . . . I was, but now mostly sad. My oldest son got two kids, my daughter--she expecting her third baby, and my baby son, the one that was here with me, he don't have no kids yet." I stayed quiet, waiting to see where she was going with this. "I kinda had this idea in my head about how we was gon' be with our grandkids and everything. Raisin' 'em up. All of us together."
Aaaah. A grandmother. This was the wisdom I saw beneath that smooth skin.
I wasn't sure what to say so I just said the only thing I could think of. "I'm sorry to hear that."
"You married?" She asked the one question I was hoping she wouldn't.
"Yes, ma'am."
She nodded slowly and just stood across that counter staring wistfully beyond me. I felt slightly uncomfortable in that moment, letting my eyes seek the safety of the computer screen in front of me.
"Marriage is a good thing," she finally said. "My husband, he wasn't that nice to me sometimes. I mean, not like he put his hands on me or nothing like that. Just. . . you know, not always nice. He had some issues, too. Like real problems, you know? But I stuck by him and we worked through a lot of stuff together. He started doing good, doing better. Then just out the blue. He don't want to be married. And my son? Oh, my baby son. . . he so mad. He fightin' mad."
But she wasn't fightin' mad. She was just sad. And you know. . . I didn't blame her. Losing your husband--and your dream-- without having any say in it was something to be sad about.
I've heard the Grady elders say more than once, "Man plans and God laughs." But usually when they say that, they're referring to light things like finding out you're pregnant with twins or getting a big job promotion. And though I'm not sure God always laughs, I know this--man plans and sometimes, things just don't go as planned.
One of my favorite songs is this song by the late Louie Armstrong called "A Kiss to Build a Dream On." There's a part of the song that says,
"Give me a kiss to build a dream on and my imagination will thrive upon that kiss."
Those words are so true, so very true. You hold hands, you kiss, and then, if it feels right, your heart fast forwards. Then the more you kiss the more it speeds up. You can't help but see yourselves holding babies and hugging at graduations and kneeling down in gardens pulling weeds together. You fuss sometimes, yes, but then see beyond all that to fast forward to rocking in rocking chairs and holding each other's wrinkled, tremulous hands on porches.
That's what I'm reflecting on today. I'm reflecting on those curveballs in life that seem, just like this patient said to me, like deaths even when nobody died. We are planners by nature, even if our plans are disorganized. The most gutwrenching things we see and hear challenge that part of us, causing us to shudder at the thought of it all playing out differently than we imagined. Sometimes, it's a divorce. Sometimes it's just having someone you counted on to be one way letting you down by being another way. Other times it's something rough like infertility or finally getting over that hump and having a child with special needs. And then, like those of us who work in hospitals often see, it can unfortunately also be illness and death. But they are all deaths of sorts, aren't they? All the air deflated from those hot air balloon dreams that started with just a simple kiss.
This morning I sat on the tub next to Harry as he brushed his teeth and asked him, "Hey, are we good? Like are we happy?"
And he said, "I'm happy and I think we're good. What about you?"
And I said, "I think we're good, too. Sometimes I just have to ask, though."
And he smiled wide with toothpaste in his mouth and that spoke volumes.
"I love you, Babe," I said.
"I love you, too," he replied. And then he spit foamy bubbles into the sink.
I decided that this moment right now was enough for me. Harry with a mouthful of Crest and my kids pretending to be the world's loudest komodo dragons in the background on a Saturday morning was enough. I thought of that lady and how sad she felt about her husband sort of dying but mostly how sad she felt about her dream that sort of died. Then I thought about how promised nothing really is. . . and I enjoyed it--that moment in time--for exactly what it was.
And so, when you get it, you try to hold on tight. You do your best to savor each morsel of now while it's on your tongue before you swallow, and when you do, you swallow hard and slow with your eyes closed. Because yes, man plans, and the rest? Well, let's just say it doesn't always go as planned.
The afternoon peace on the back hall of that ward served as a perfect place for that lady and me to connect that day. We talked for a while more, and it felt good. Eventually, the conversation chugged to a halt and we began exchanging parting words. She thanked me for listening and I thanked her for sharing. She reached out and gave my hand a quick squeeze before she left.
I smiled and tried to be encouraging. "Maybe you can make some new dreams."
She stared at me with glassy, tired eyes and replied with a forlorn sigh, "You know what? Sometimes . . . . you just don't even know how."
***
This is what happens when imaginations thrive upon kisses. . . . I cry every single time I see this. Every. Single. Time.
. . and of course, Satchmo is now playing on my mental ipod. . .
Last weekend the boys and I visited with my friend Cassandra M. at the new home that her family just had built. Cassandra has two daughters, Caitlin and Carly, and a sweet little son named Chase that just turned one. I initially thought that my rough and tumble boys would be way too rough to play with her sugar 'n' spice girls. In fact, for that reason, my plan was to be there for only thirty minutes to an hour, but we were both pleasantly surprised at how well Isaiah, Zachary, Caitlin, and Carly played together. We ended up hanging out for nearly three hours!
Well. . in addition to dousing one another with water hoses, playing freeze tag, and a few rounds of "Mother May I?" I began to notice my son Zachary making this expression that I laugh out loud each time I recall. Every time he spoke to Carly, Cass' almost four year old daughter, his mouth curled and his eyebrows raised in this flirty-slash-blushing way.
Usually Isaiah (the Playa) is the one that we catch putting the moves on little girls at the playground. He has no shame in his playa game, either. Without fail, Isaiah sees a cute girl, chats her up and next thing I know all I hear is, "Isai-yaaaaah! Isai-yaaaah!"
Ugggh.
THEN, as soon as the Playa gets into the car, within two seconds he's announcing that the girl "wants to marry" him. Harry thinks it's cute, and me? Well, I think it gives me heartburn.
My baby, Zachary, on the other hand, is content being Mommy's baby most of the time. When he does get smitten, though, he's a lot cooler than Isaiah about his mojo. Zachary simply blushes. . .or unfortunately tackles and punches the object of his affection. But this? This was something altogether different.
"OMG!" I said to Cassandra, "Look! Zachary is totally crushing on Carly!"
"Girrrl, I think the feeling just might be mutual," she replied with a hearty laugh. As I watched Carly batting her little lashes, I knew Cassandra was right.
And so we watched. And we laughed. And we laughed some more. As we witnessed Zachary putting the mack moves on Carly--and Carly letting him. Who knew that he was Zach-the-Mack?
Lawd. . . .I'm pretty sure I witnessed Zachary's first date. Ugggh.
Don't believe me? I've got proof!
So. . . .without further ado, I lighten things up by bringing you this week's (belated) top ten!
The Top Ten Shots from when Zachy met Carly: The Firsts.
#10 - The first "creep."
"Okay. . . sssshhhhh. . . don't make too much noise or else someone will hear us!"
#9 - The first parental bypass.
"Old school trick--put it in neutral and roll it out first--this way nobody will hear the engine when we pull out!"
#8 - The first "do you even know where we're going?"
"Zachary, are you sure you know how to get there?"
#7 - The first "Ugggh, woman!"
"Please don't nag me, Carly! I don't need directions!"
"You don't have to be all snippy about it!"
#6 - The first "I'm sorry."
"I'm sorry, Carly. . . uhh. . I like your hair."
#5 - The first "put on your seatbelt" reminder.
"Let's head out!"
"Zachary, don't forget your seatbelt. . .do you hear me?"
#4 - The first "do you even know what you're doing?"
"Zachary, is that orange light supposed to be on?"
#3 - The first "not really but I will act like I do."
"I don't think it means anything. . . wait--let me listen to the engine for a minute."
#2 - The first "sigh."
"Okay, I think everything is going to be fine."
#1 - The first "hope we don't get busted."
"I hope your Daddy doesn't show up."
Bonus shot: The first crush.
***
Wait--you mean to tell me they grow up?
So. Not. Ready. Which reminds me of something my blogger-friend Psonya at Pserendipity wrote recently about her six year old and his THREE girlfriends. . . .
Last weekend, Harry and I went to this big ol' summer soiree. The event was called "Sundresses and Seersuckers" and was the signature fundraising event for my husband's fraternity, Omega Psi Phi. Held in an outdoor lawn amphitheater and planned with painstaking detail, everything from wrist bands to portable potties had been discussed, voted upon, and then rediscussed and revoted upon. The reason I know this is because Harry was one of the key organizers, and literally, this thing had our lives turned upside down for the last six months. As we drum-rolled closer to the big night, we both got a little obsessive compulsive about what we'd wear. I know, I know. . .it isn't necessarily an earthshattering problem to deal with, but stay with me. . .I'm going somewhere with this. . . . .
After a few weeks of perusing my favorite shopping haunts (that would be Target and Loehmann's--hello?) I finally found this amazing full length sundress and had decided to pair it with a special pair of feather earrings that had been handmade and given to me by Parissa, one of our recently graduated medical students. When I tried on the whole ensemble, I felt good and happy and confident and right. I even danced like Beyonce in the mirror a few times and would have done a few Lady Gaga moves if Zachary hadn't walked in.
Yep. I felt that good.
On this picture my earrings make it look like I have a mullet, but trust me they're rad!
On Friday evening (the eve of the event), Harry proudly showed me his seersucker vest and linen trousers--all pressed and ready for this lovely evening jazz event on the lawn. "Let me see what you're wearing, Babe," he said in the most unassuming way ever. And it was unassuming because he had no ulterior motive. He just wanted to see what I was wearing, too. And seeing as just the night before I was dancing like Beyonce, you'd think that I would have shown him in two seconds flat. But I didn't.
"No," I told him, "because I really like what I've chosen and if you're all like 'mehhh' when you see it, my feelings are going to be hurt."
Harry groaned and responded, "Ugggh! You are so sensitive! You know I'm going to think you look beautiful no matter what! Show me!"
I shook my head and didn't budge. "Nope. Anything short of your mouth falling open and drool coming from your mouth will be unacceptable, so no!" I started laughing and blocking my closet with my outstretched arms. "I'll be like a bride. . .where you'll have no choice but to tell me I look gorrrrrr-geeous when you see me tomorrow!"
Harry just shook his head in that way he often does when he used to say, "Crazy girl"--but doesn't say any more because I told him that calling me "crazy girl" wasn't nice. Just like I used to tell him that calling me "oversensitive" wasn't nice, so he stopped saying "oversensitive" and instead replaced it with just "so sensitive." I think those changes took place because I was being well. . . sensitive.
Harry is right. I am very sensitive. In fact, don't tell him this, but I will even admit that I'm even a bit oversensitive at times. I often hope I'm not hurting someone's feelings and then, if I think I did, I worry. I get choked up when patients are in the hospital for prolonged periods of time and they don't have flowers. So much so that I consider buying them some. But most of all I ruminate a wee bit too much over unexpected criticism. (The key word there is unexpected since most of my shortcomings I've spent countless hours already analyzing. . . um, yeah.)
Yeah, it's true. Despite how confident I might seem. . .ah hem. . . I'm sensitive like that. About some things.
Today, I'm feeling sensitive-- and maybe even oversensitive-- about something that I almost always feel very confident about: how I feel about my Grady patients. Working and teaching-- and then writing about Grady Hospital has been a joy that is indescribable. These narratives have allowed me to introduce you to the amazing people, moments, learners and lessons that I've been afforded for the last decade. . . .
Man.
I love Grady. And what makes Grady Grady is the people inside of it. . .the patients, the staff, the physicians, the students, the families. I try my hardest to make this blog a neverending love letter to Grady and to life. . . and an opportunity to pay those lessons forward. These feel-good moments are no longer just my own. . . now they have become those of someone else, too. And for this reason, I generally feel my most confident when wrapped in my cocoon of Grady stories.
Until today. Instead of my top ten, I wanted to share something that happened today that has me reflecting. I hope you don't mind. . . . .
Today, I received this comment in my comment box:
"Today will be my last day reading your blog. I think you are a gifted writer and I enjoy your writing style. However, although you may not see it, you degrade your patients from the (rural) South and make snide comments on their literacy quite often. I know that you write in this broken English to illustrate their vernacular but it's a bit rude to me. Your kids are now from the South - how would you feel if a Doctor questioned their literacy right off the bat? Made fun of their accent (if they were to have or develop one?) Best of luck in your future endeavors."
by Anonymous on You had me at "Oh, Hell No!"
Wow.
At first I clicked "spam" and in my most don't care voice, decided that I'd just say "yeah, whatever." But because I believe that self reflection is important--particularly in the face of criticism--I allowed myself to ponder what this anonymous reader felt strongly enough about to type into Blogger.
Now.
I know that one of my girlfriends would say, "Girl, please! You are not about to address that are you? Don't even give it any airplay!" But that's not me. I am sensitive. And not just sensitive in that silly way I was about Harry liking my fancy feather earrings that were handmade by a med student-- but sensitive to an accusation that I degrade or make fun of a people and a place that I deeply and genuinely love.
So. I thought about those words. I read them and reread them again and let them sting my cheeks. I searched for the truth in them, sifting them like a goldminer's screened pan for some golden ah hah moment to emerge glistening like a precious metal in the sun.
Then, as sensitive as I am--I told myself what I know in my heart is the truth. It's not about a critical comment. It's all about Grady.
Sure, it makes me feel a bit bummed to know that someone somewhere thinks that I knowingly or unknowingly degrade or belittle my rural Southern patients (or patients from anywhere for that matter.) No, it doesn't feel good to think that creating the real voices of my patients when I write is offending someone somewhere. But. What I know for sure is this--those feelings aren't the ones that made me feel uneasy. It is only the thought that a patient or their loved one might feel that way, too. And I could be wrong, but my sense is that the person who wrote that well thought out comment--with all due respect--was neither of these.
And so. This is not a response to Anonymous' comment, although I deeply respect it and appreciate the raw honesty. (Hell, I wouldn't continue reading anything that I found offensive or degrading either.) So, for Anonymous, all I will say is that I have appreciated you reading, because I have.
Now. This part is a response. And please know that, no, this was not my first not-so-pleasant comment, and no, I don't agonize over everything. But this--this was different. So this response is for my patients at Grady and all of those somehow connected to this beautiful magical place that, day after day, serves as my home away from home, my church away from church, and my school away from school.
****
Dearest Grady,
This month marks our ten year anniversary together. I can't believe it's been ten years, but the more I think of all that has happened in this time, the more I realize that it has been a decade indeed.
When we first met, I was a single girl about town. . .fresh out of a chief residency and slightly terrified of your larger-than-life persona, fire-breathing clinical settings, and legendary reputation for turning boys and girls into men and women. Ten years later, I am a wife and a mother of two. I'm a residency program director, a student advisor, and even someone who gets to be on television-- but still in many ways, that same little person . . . . still in awe of all that you encompass.
Early after I started here, I realized that I loved you. Maybe even before. Your imperfections, your laughter, your tears, your triumphs, your tragedies, and even your tendency to climb into the back seat of my car and ride home with me every single day. Yes, I loved you from the start.
It first began with stories to my family and to medical students. I'd tell them all the things you'd told me and taught me. I'd share your best jokes, making sure to get the punchlines correct and the comic timing just right. I couldn't wait to paint a picture of the stories you'd given me that tugged on my heart strings then and still some ten years later.
Because I loved you, I wanted them to first know you and then love you, too. The real you, you know? Not just the one that folks think of when there's been a drive by shooting or a three car pile up. But the you nobody really knows unless they pull up a chair, take off their coat, and get comfortable for a while. For this reason, I began writing about you and sharing you with the world.
At first, I agonized over parts of the introduction. Should I use your name? But how can I really do you justice if I don't? And so I introduced you by your God-given name. Fortunately, your "parents" were okay with that, and I have been careful about honoring their kindness in letting me do so. Next, I wondered about your voice. Should I let them hear your voice? I quickly decided that of course I should because your voice is beautiful. And even if sometimes it looks a bit odd to someone when they read and then hear your voice, the one I try my hardest to use is yours. To me, it sounds like music. . . .not funny or foreign or inferior. . . like music.
I apologize if I've ever said or done something that made it sound like I thought I was someone better than you, because you have to know--I do not. I try with all my might to show the piece of you in every single one of us, the piece of you inside of me. You just have to believe that.
Someone I introduced you to once said to me, "there are no 'those people'." I loved that comment because it embraces the best you have to teach. There are no those people. People, yes. But not "those."
. . . And I just have to believe that if you've done that for me, that every time I introduce you--yes, the real you-- to someone, you're doing it a little bit for them, too.
The other day I was working with a resident who'd just seen a patient for a medication refill. According to the resident, this fifty-something year-old woman had missed three out of the last four continuity care visits opting for quickfire "med refill only" encounters instead. Fortunately, her only medical problem was high blood pressure, and despite her less than ideal approach to having it managed, it was under control. She'd even had labs drawn after the last refill, all of which were 100% normal.
"Did you review health maintenance screening tests with her?" I asked thinking of things like mammograms and colonoscopies. I noted her age--over fifty--and wondered if this lady had kept appointments for these things even if she wasn't too keen on getting a full physical.
"Screening tests? No way. She pretty much shut down everything except the occasional pap test."
I furrowed my brow and sighed. "Did you ask her why?"
"I did, Dr. Manning. And it was kind of odd. She just kept saying no. Even when I asked why, she just kept saying 'I just don't want it, that's all.' And when I asked if she'd ever had a mammogram or a colonoscopy, she squished up her face and shook her head."
"That's unfortunate," I responded. "Do any cancers run in her family?"
"That's the part that stinks the most, Dr. M. One of her immediate family members died of colon cancer like in their forties. I tried to get her to reconsider using everything I could but she wasn't budging. She just kept on saying no. As a matter of fact, she kept saying. . ."she paused and seemed to be deciding whether or not to go on. She glanced back up and finished, "she kept saying, 'Oh hell no.'"
We both let out a nervous chuckle. Then my wheels started turning. . . .
A black woman in her fifties refusing screenings and missing appointments in an indigent care setting? In the southern United States, no less? Hmmmm. Why is this happening? Is it a trust issue? Or what if this is a literacy issue? Wait. What if it's a financial issue? Or a little bit of several things? Hmmm.
Instead of speaking those thoughts aloud, I just kept staring at the resident intently. She knew I was thinking, so she waited patiently. "Let's go talk to her."
And my resident replied, "I'd like that."
My guess is that this intern was banking on me closing some cultural divide that she, a well-meaning, blonde hair/blue-eyed doctor, might be lost inside of with this woman who could sho nuff pass for one of my first cousins. And I have to admit--she wasn't the only one.
When we walked into the room, we found the patient reading some kind of romance novel. "What's that you're reading?" I asked. She turned it over and showed me the cover. Some Fabio-looking dude held a Raquel Welch-looking woman tightly in his arms.
"Romance," she answered with a timid smile while dog-earing the page.
I remembered some fleeting teaching point I'd once heard about people carrying books as a deterrent when literacy was an issue. Considering that limited literacy is a major issue in this part of the country and at our hospital, I had to at least consider it. But this didn't seem like the case with her. This lady was doing exactly what she told us -- reading about some Fabio-looking dude putting the moves on people during the wait.
We chatted for a few moments about her blood pressure, weight, and keeping appointments. I implored her to see us at least every six months, especially since she was on three different blood pressure medications. We listened as she explained about the hassle of "all that other stuff they want to talk about" during the continuity appointments when all she is interested in is getting her high blood dealt with.
Hmmm.
I sat as still as possible to keep her from feeling rushed and allowed her to finish her thoughts.
"Sometime you jest wont to get in and get ya medicines," she said with a sideways smile. "Y'all be on to some whole other thang. Tellin' somebody they need to lose weight. Signin' 'em up for a bunch a other thangs that they ain't even in-trested in."
Yikes. I didn't even know where to begin. "Uuuuhhh. . . . yeah. . .Dr. Ashley was telling me that you aren't too keen on some of the screening tests." I decided to dip my toe in the water with this to see what she'd say. She simply stared at me expectantly, mindlessly shuffling the pages of the Fabio-book under her thumb. She totally had my number.
"Listen," I spoke carefully, "I just want more of an idea as to why you don't want to get a colonoscopy in particular. I mean, you definitely need the mammogram, but you lost a parent to colon cancer so I just . . . look, I just don't want to miss an opportunity to--"
"I don't want a colonoscopy." She held my gaze and wouldn't move.
"The reason is that I don't want it. Somebody ever offer you something and you say, 'No thank you?' You ain't got to tell nobody why. Jest a 'No thank you' is sometimes all you gon' get."
I nodded my head slowly as our eyes continued to face off. "If I offer you a stick of gum and you say 'No, thanks' I'm okay with that, you know? Because that's not life-threatening. But if you lose your mama or your daddy to colon cancer and you don't want me to check out your colon, that's different."
"Not to me," she shot back. "If I say I don't wont no gum, I don't want no gum. Don't care how fresh iss gon' make my breath."
Damn. This was tough. I nervously cleared my throat and gave a nod that said touche. I drummed my fingertips on my lips thinking of what to say next. She still watched me, barely blinking.
"Ms. Johnson, you have a right to make your own decision. But. . .I'm not going to just shrug my shoulders and say, 'Whatever.' I mean, yes. That would be a lot easier than discussing it, but it wouldn't be right." I stopped to see if she was okay, and her face softened a bit. I went on.
"Look. You're a black woman, and the truth is -- when it comes to a lot of these cancers, we were dealt a crappy hand. Guess who is way more likely to die of breast cancer?" I pointed at the brown side of my hand and then aimed the same finger back and forth to us both. "Guess who colon cancer is the most aggressive in and the most likely to take out?" I repeated the same gesture.
"Why is that?" she asked. I felt super excited that she even did because it was the first olive branch I'd received during the whole discussion.
"Partly because we don't always get our screening tests. But it's some other reasons, too, like how we are made genetically. . .you know. . .like what we're made of." And sure, my use of "we" might have seemed like a shameless attempt at bringing home my point, but regardless of all that, it was true. "I mean. . . . look. You just. . I mean we just. . .are the main ones that need to be getting signed up for colonoscopies and mammograms. For real."
The room fell silent as she nervously flipped the pages over and over. After a few moments, it became a bit uncomfortable, so I finally broke the silence. "What do you think?"
"I think I don't want a colonoscopy. Or a mammogram. But I'm gon' think about both of 'em." Then she looked over at the resident doctor and added, "And nen we could talk more 'bout what I'm feelin' when I come back in four weeks."
"You will come back to see me in four weeks?" my resident chimed in incredulously.
"Yeah, I'm gon' come back to see you. And I'm on' thank more about what y'all told me. I might not change my mind, but I like that y'all took the time. Both a y'all. 'Specially when all I signed up for was the refill. I 'preciate that."
And so that's how the encounter ended. We typed into the plan that she'd come back in four weeks. . . and that she'd think about getting a colonoscopy and a mammogram.
And you know what? Something inside of me tells me that at some point she will.
My office is next to that of one of the smartest people I know. My friend and fellow Grady doctor, Lorenzo D., is the kind of scary-smart that makes your eyes narrow and your head hurt at the same time. But the thing about it is. . .he's not obnoxious-smart or annoying-smart at all. He's just a medicine nerd that gets all wild-eyed and foaming at the mouth when a patient comes in with a real puzzler. And, trust me. This dude can almost always come up with something very close to striking distance of the diagnosis, and in most instances, he hit the bulls eye.
I like knowing that his office is next to mine because I always learn something when I lean into his doorjamb.
Today I did just that. I stopped in the doorway and propped an elbow on the frame. He looked right up and gave a big, boyish smile. Then, he said what he always says.
"What's up, Kim Manning?"
The way he says that always makes me smile--especially the way he runs my name together such that it sounds like "KIMMANNING."
"Nada mucho," I answered, which is what I always say whether there is something going on or not.
I asked a few residency program related questions and we both commiserated a bit about how behind the eight ball we both were with regards to resident orientation. Next we got on to the favorite discussion of all medicine nerds -- patient care.
"I saw the most AMAZING case in the clinic yesterday!" Lorenzo exclaimed. "Like, seriously. . . it was really amazing, KIMMANNING. I almost fainted."
Okay. Let me just digress for two seconds to mention something that just popped into my head. No matter who you are, you never, ever want to be the subject of a "great case." "Great Cases" usually signal badness. . .or such rare and scary things that, by definition, the outcome just can't be good.
Now, interestingly, Lorenzo chose the word "amazing" instead of "great" which immediately made me wonder if it meant that it was not necessarily horrible but more of a stumper. Looking at Lorenzo's giddy, medicine-nerdy smile I knew I was about to find out.
Fellow medicine-nerd Lorenzo D. today in his office
Lorenzo went on to describe this unusual complaint in a very young immigrant gentleman.
"It was weird. . . . he was seen in a few emergency rooms, and each time they discharged him home. No one could get to the diagnosis. But the why of the story just didn't make sense to me."
He explained that he kept asking the resident physician questions but was having trouble making sense of it all. "I decided to go in and just repeat everything," Lorenzo said shaking his head.
Next, he told me that the resident seeing this patient was excellent. I'm sure this (excellent) resident was quite frustrated with his barrage of queries and downright annoyed with the twenty minutes he was about to spend duplicating the entire encounter.
"Has this happened before?" Dr. D asked the patient. The patient nodded and shared that once or twice this problem happened in his country. Hmmmm. After a few more questions he then discovered that this man had lost some sixty pounds--without trying. Not normal.
Next came a careful physical exam. Then more careful historical questions. And BOOM! The light bulb came on in the medicine-nerd light house. He was waving his hands all wild-like as he walked me through the moment when he figured out what was wrong with this patient.
"Man! It was AWESOME!"
He said "awesome" in the Teenage Mutant Ninja Turtles kind of way, or better yet, in that way that is almost always preceded by "totally."
"Dang. I don't think I would have known that, Lorenzo." And I meant that because this scary-smart friend of mine pulled this diagnosis from way down deep in the cob web part of the senior resident board review section of the brain.
"But you would have been bothered enough to wonder what the heck a twenty-something year old dude was doing with such horrible weakness and unusual labs, for sure. And then you would have dug deeper and asked questions until you figured it out."
I stepped into his office and sat on the end of the chair across from him and thought about what he was saying. The more I thought, the more I realized that he was right. Even if that obscure answer wasn't in my fund of knowledge, I probably would have found it after doing a literature search for things causing this constellation of symptoms, findings and lab values.
Dorothy: "But why didn't you just tell me?"
Glenda the Good Witch: "You had to learn it for yourself."
When I was a resident, I was rounding with one of my medicine-nerd heroes, Dr. Rick Blinkhorn. I'd just presented this patient who had fever of unknown origin and a bunch of nonspecific other complaints. I knew that Dr. B was pretty hard core at the bedside, so I had tried my hardest to come up with a working diagnosis for this patient, but no cigar. I felt like a failure when I finally finished up the presentation with "Assessment: Fever of Unknown Origin." Because this otherwise healthy young woman did have a fever, and as for the origin of it, I had no idea.
Now check it. Dr. Blinkhorn strolled into that room all suave and debonair-like. . .white coat starched so hard it could cut you bad and salt and pepper hair in a signature military buzz. . . .and commenced to show me how to do a sho' nuff and bona fide history and physical. This dude asked questions I never even thought of asking and next did a head-to-toe examination on her that was so fluid and thorough that it made my head spin.
"Let me ask you," Dr. Blinkhorn said to the patient with a furrowed brow, "do you have any pain in your legs?"
And I remember that this lady prepared her mouth to reply but before she did he added, "Specifically, do you have pain in your thighs?"
And she widened her eyes and said, "You know WHAT? As a matter of fact I do. It's weird. I told that man in emergency that I had this weird ache on the front of my thighs, but not the back!"
Blinkhorn looked over at me, in front of my whole team of interns and medical students, and said, "Dr. Draper, if I say 'anterior thigh pain and fever,' what should be the next word out of your mouth?"
I squeezed my eyes shut and google-searched my brain for something, anything. "Influenza? Wait, no that's calf pain. Umm. . .rhabdomyolysis?" I shook my head knowing that it wasn't that, either. "But Dr. Blinkhorn, her muscle markers were all normal so it can't be rhabdo, right?"
He stared me in my eye without flinching. "Bilateral anterior thigh pain and fever," he repeated. I held his gaze and shook my head. I had nothin'. Dr. Blinkhorn knew I was a medicine-nerd so he wouldn't give me the answer. Instead he turned back to the patient and began inspecting her legs some more. He removed her socks and studied her feet. Closing one eye he glanced over his shoulder and asked, "What happened here with your toenail?"
The woman explained that she'd had a pedicure technician that was a bit overzealous while pulling hangnails. "It was bleeding and everything," she said with a shudder. "But it's fine now."
After a few more words with the patient, Dr. Blinkhorn put his eyes back on me. "Anterior thigh pain and fever in a patient who had a distortion in the skin's integrity."
I sighed hard and shook my head. "I just don't know."
"Find out," he replied matter-of-factly. "Better yet, go check her labs again and you will know the answer."
I knew he had just heard of this patient for the first time less than ten minute before. What did he mean by, 'Go check the labs?' I kept staring at him for a beat and then escaped to the nearest computer to recheck the latest labs. After a few key punches the screen popped up. Nothing new.
I held my hands up and mouthed, What the hell is he getting at? Before I could say another word, the area clerk handed me a slip of paper with a "critical lab value."
"Preliminary Result: Blood Culture two out of two bottles growing gram positive cocci in clusters."
I couldn't take it. I needed to know what he was talking about. Searching the pre-Google internet, I went to PubMed to enter the search term: "Anterior Thigh Pain", "Fever", "Bacteremia."
Up popped the answer. "Anterior thigh pain as an indicator of bacteremia." Published right there in the Archives of Internal Medicine.
"Damn!"
I immediately covered my mouth, forgetting that I was in earshot of my attending. Then I said it again as I skimmed the abstract to that article. The second time, I didn't even bother covering my mouth. This "damn" wasn't a "damn, I should've known that!" kind of "damn" either. It was a "damn, this dude knew what was wrong with this patient just from the bedside." Or better yet "damn, when I grow up, I'm TOTALLY going to roll up on a patient's bedside and nail a diagnosis just like this."
When I went back to Dr. Blinkhorn and told him what I'd learned, he smiled and put his hands on both of my shoulders. "You're a very good doctor, Dr. Draper, because you're curious. Medicine isn't about knowing everything. It's about being so curious that you hunt until you find the answer."
I nodded and smiled, respecting the Mr. Miyagi and the Jedi Master all up in this moment. Then he added these words of wisdom:
"Stop. Look. Listen. If you do that, you will almost always get to the bottom of what is going on with your patients."
I never forgot those words. Ever.
Turns out that Lorenzo's "AMAZING" case was something completely treatable and reversible. It was also something that could have been life threatening if someone hadn't stepped in and used the power that you get long before medical school: To stop. To look. To listen.
***
"Curiosity may have killed the cat, but it saved the patient."
Honestly? I write this blog to share the human aspects of medicine + teaching + work/life balance with others and myself -- and to honor the public hospital and her patients--but never at the expense of patient privacy or dignity.
Thanks for stopping by! :)
"One writes out of one thing only--one's own experience. Everything depends of how relentlessly one forces from this experience the last drop, sweet or bitter, it can possibly give."
~ James Baldwin (1924 - 1987)
"Do it for the story." ~ Antoinette Nguyen, MD, MPH
Details, names, time frames, etc. are always changed to protect anonymity. This may or may not be an amalgamation of true,quasi-true, or completely fictional events. But the lessons? They are always real and never, ever fictional. Got that?
