Gone too soon.

Grady will never be the same.

Clinician. Educator. Colleague. Grady doctor. Friend.

Husband. Brother. Son. Soul mate. 

Servant.

***

 My dear colleague and friend. . . .

You have fought the good fight. 

You have finished the course. 

You have kept the faith.

Yes, you have.

And we will remember. We promise we will. 

Your friend,

~ Kimberly

***

In loving memory of Ildefonso Tellez, MD, MPH 

 Sunset 9/14/2011

Lourdes~  Y tu, tambien.

"Lo, I am with you always, even unto the end of the world." ~ Matthew 28:20

Now playing on my mental iPod. . . and now yours.  Patti LaBelle singing "You are my friend."

Top Ten: Automatic entry.

"Wait, you did what? Oh Lord. Go on in, baby."

The following people, regardless of what they believe and what they have or haven't done, will get an automatic pass into heaven.

1. Social Workers at Grady Hospital. Or any public hospital. Because it is some social stuff going down for real in these places. And the social workers are magicians.
2. Any faculty member who teaches medical students statistics, epidemiology or evidence-based medicine. Because it is 100% painful. Wait. Maybe I'm just the one who finds it painful. Hmmm.
3. Nurses and nurses aids. Particularly those who are involved in changing diapers of grown people. Because there is something about "grown people diapers" that are on a whole 'nother level.
4. That cafeteria lady from the elevator that day. 
5. The decubitus ulcer (bed sore) team. They literally walk around the hospital and make sure that bed sores are okay. All. Day. Long. Oh yeah. I forgot they have one other duty--they look at colostomy bag sites, too.You heard me. Colostomy bags.
6. Anyone who does anything related to Psychiatry.  Especially Psych ER triage nurses and physicians.
7. Security officers in the Grady ER. Okay. So somebody is going off on somebody. And that somebody has been working at Grady forever and can usually hold their own. But when they can't, somebody calls Security. Which means they get to deal with the most off-the-chain-est of them all. Automatic pass.
8. Urologists who work in public hospitals. Not the private practice ones. But the ones that called in to place Foley catheters in uncircumcised males who haven't performed any form of personal hygiene for greater than or equal to six months. (Sorry, just threw up in my mouth a little bit.)
9. Grady ER Triage nurses. Can you just imagine the stuff they get shown? As the Grady elders say, "Lawd, t'day!"
10. All podiatrists. Private practice included. Because feet in the hospital, for the most part, are really gross. Particularly feet that are in need of a podiatrist. So them? Whew--they all get an automatic pass. Especially the ones responsible for those really, really thick long curling yellow fungus-infected toenails. Eeewww.

*Speed Pass/VIP entry*

#37/41

Standardized physical exam patients. No, not all of them. Specifically those who allow medical students to learn how to do pelvic exams or rectal exams on them. Oy!

41 pelvic examinations + 82 hands that have never held a vaginal speculum let alone used one + 0 medical need for any of it + all in 1 day  =  VIP entry into heaven. This includes a velvet couch, a Turkish robe and flat screen televisions everywhere you can turn your head. Because you earned it.

#41/41

This? Now this is a whole different kind of altruism. Other than explaining to St. Peter how in the world you decided that you would do this, you get a speed pass. A VIP ultra-speed pass. Because one pelvic every three years pretty much sucks. But 41 pelvics in one day?  41?

*thump*

(That was me fainting.)

***
Happy Wednesday

P.S. My ever-insightful blog-friend-slash-fellow-medicine nerd Dr. Tony B. at Everythinghealth reminded me of another good one in her comment--the environmental services/housekeepers in the hospital. OM-expletive-G. Please--add them to the SPEED PASS line. For real.

Represent.

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

 

Part story-Part late night rambling. Read at your own risk. . . . 

"You know, I'm fixin' to move."

These were words I heard spoken by one of my clinic F.P.'s when I bumped into him in the hall. Always chatty, I knew this was just the beginning of what would be a detailed story.

Mr. Kiefer widened his eyes and spoke before I could respond. "I was hopin' I was gon' see you! I was thinkin', 'Now, if that woman is up takin' care of folks upstairs in the main hospital and not in this clinic I'm gon' march right up there and find her!'" He let out his signature cackle.

"Hey there, Mr. Kiefer. What do you mean 'fixin' to move?' What's that about?"

My tone was easy and familiar, and rightfully so. I've known him for nearly eight years and have cared for him shoulder to shoulder with three different resident physicians--four if you count the new intern who assumed care after the last one graduated. Usually, Mr. Kiefer made a point to poke his head into the Physician's Room with some kind of teaser to get me in the hallway chatting with him before the visit. This time he caught me coming out of another patient's room so did the honors right there.

Sure. Mr. Kiefer is what Seinfeld would refer to as a bit of a "close talker." He breaks all kinds of rules from entering personal space to speaking too loudly to dropping f-bombs when and wherever he damn well pleases. But I adore him though--especially his little teasers before the visits.

Most of the time it's something like, "Did you know I went and got my medicine on that four dollar list? Hell, it add up if you got four times fourteen!"  (insert signature cackle)

Always something like that. Lighthearted and jovial. But this day wasn't like that. His voice was decidedly serious--and even though he cracked a joke, there was a sadness in his usually twinkling blue eyes.

"Moving?" I repeated.

"Soon as I get all my business straight I'm movin' down to the Alabama gulf shore.  The other L.A."

We then said in unison, "Lower Alabama."  As we shared a laugh, he slapped his knee in the animated way that he always does and shook his head. 

"Won't even get a chance to pick on my new doctor since I'm leavin'.  You know how I like 'em when they're all green."  He giggled as I followed him into the room, but just like that I saw it again. A wistful sadness that washed over his face and disappeared like vapor.  I knew I'd get to see him more after his resident doctor discussed his visit with me, but for whatever reason, Mr. Kiefer wanted more of my attention than usual.

I leaned on the door jamb at first; then I decided to step in and follow my instincts. Yes. There was work to be done and probably someone waiting for me to precept their patient with them. But Mr. K had something going on.

I softened my voice and sat on the foot rest at the end of the exam table. Looking up at him, I asked, "So what's going on?"

"I got robbed. At gunpoint."

Originally I'd positioned myself with my elbow on my knee and my cheek cradled sideways in my hand--relaxed but concerned. His statement caught me by surprise; I stiffened my spine and furrowed my brow. "What? That's awful. I'm sorry."

"Kicked the door straight in. Point that gun right in my face like a old dog. I was holding a hot cup of coffee and plum dropped it all over my nether regions!" He let out an anemic laugh. I could tell it took a lot out of him. This wasn't funny.

"Oh my gosh, sir. Robbed? I'm so sorry to hear that!"

"The guy had a mask on and came marching all through my house hollering at me and everything. He was like, 'Look old white man! Where your gun? Make one move and I'm gon' blow your head off.' But hell, I was too busy worryin' 'bout my nether regions!" Just telling the story seemed to scare him.

I narrowed my eyes and sighed.

Look old white man. 

Damn. Those words spoke volumes. It told me that more than likely, whoever put this gun in sweet Mr. Kiefer's face looked like me and not him. Just like some white folks say "this black guy" when speaking of an African-American man, I'd be lying if I hadn't seen that reciprocated. Seems to me like anyone who looked like Mr. Kiefer would have been just fine to say, "Look old man"-- no adjective needed. 

Look old white man.

Damn.  Who could be sweeter and more harmless than Mr. Kiefer? Who?  This man lived in his same neighborhood for longer than I've been alive. That neighborhood changed big time and all those working poor Caucasians tipped out toward outlying counties when the going in town got either too tough or too expensive. But not him.

"I ain't scared a nobody. I don't mess with them and they don't mess with me.  I got my dogs and my cats and my Smith and my Wesson," he'd always say. And that's what he'd been saying for the last eight years so I believed him. But today? He was less feisty. There was fear in his eyes.

Look old white man.

Really? Mr. Kiefer? Who would want to hurt him?  I shook my head and pressed my lips together. I could feel my face getting hot and my heel tapping to let out the mounting emotion. I wanted to kick somebody's ass. Right now. Kind of like the way you yank your kid up by the shirt for embarrassing the crap out of you. Only worse than that.

"Got me a nice little place to go down near Mobile. Dogs gon' love it. Now them cats, you know cats got a attitude so ain't no tellin' what they gon' say. You know Miss Ellie had some kittens."
 
And you know, the dogs and the kittens and the fact that Kroger makes some good instant coffee is where our conversation went next. I let it because that's where he wanted it to go and seemed to need it to go.  I stayed silent and offered obligatory smiles and chuckles at all the right times. This image of this seventy-something year old harmless man being startled so bad that he dropped hot coffee all over his crotch haunted me.  He talked and talked and I can't remember a single thing he said after "Look old white man."

Damn.

Or as Florida Evans would say, "DAMN! DAMN! DAMN!"
  
No. I do not have some deep way to end this. No I do not have the answers to all of this. I don't. I do know that hearing that raised my blood to boiling point quick fast and in a hurry.  Oh--and before someone says, "You don't know if the dude who kicked his door in and said 'Look old white man' was of color!" And to that I say this:

0_0 ------>  uuuuhhh, okay-----> 0_v


That reminds me. When I was a cheerleader at my 99.9% black high school and we went across town to a 99.9% non-black cheerleading competition this was what was said in our huddle:

"You better get out there and REPRESENT."

Represent.  That's an all encompassing word in the hood and is usually meant to get you shadow boxing. When you "represent" it means you "show up and show out" -- giving your best effort on behalf of every single person out there that identifies with you.  I heard those words again when I left Meharry to go to residency in Ohio.

"You better represent!" one of my sista-professors said with a 100% straight face. That meant "don't embarrass me." That meant "if you look bad, you make me look bad."

And sure, I've passed that torch and have spoken those words to more than a few medical students with that same dead pan.  Hands on my hip and a growl in my voice--"LOOK--I'm gon' tell you like somebody once told me. . .you're representing more than just YOU up in here, alright? So you better represent, do you hear me?" Oh and trust. They know exactly what I mean. I feel proud when I see them taking that to heart and doing their thing--you know--really representing.

Then, I turn on my television and see this man with this buttery smooth voice speaking to our country with his wife next to him who happens to be from the South side of Chicago.  I see her and I get to poke my chest out some more because even if folks are saying he isn't really this or that, there's no mistaking that she's sho' nuff from Chi-town and knows how to double dutch and cabbage patch. I look at her walking with queens and diplomats with her Harvard Law degree and her chiseled arms and I point at that television yelling, "YOU BETTER REPRESENT, GIRLFRIEND!" And that's my way of saying "you make me proud."

If that's not enough I look out of the window from Grady and can see the steeple of Ebenezer Baptist Church where a man represented so hard for the people that 200,000+ folks came to D.C. to hear him speak and he even got a whole holiday got named for him.  Talk about representing!

And then.

After all that, I hear this. Look old white man. This is how you represent? Kickin' in a door waving a four-four and scaring the shit out of somebody who's just tryin' enjoy a cup of instant Kroger's joe up in his paid-for house? The same one he grew up in and had the guts to never leave?

Seriously, y'all?

No, it doesn't make me any less proud to be black but it does make me mad. I know it's complex and I know there's like 400+ years wrapped somewhere in some part of it and I know all that. But I'm still mad.  Because no matter what anyone anywhere says, as a mother raising black boys that person who kicked in his door was representing us, too.

Damn.


"Hey, Dr. Manning? You listenin' to me?"

"I'm sorry. What was that you said, Mr. Kiefer?"

"I said, 'Look like I made you sad tellin' you all that. I'm sorry, Doc.'"

I sighed hard and told him exactly what was on my mind.

"Yeah, man. I'm sorry, too."

***

Of mouses and men.

While drinking coffee in the kitchen over all of the work I'd been procrastinating on:

Zachary:  Hey Mommy!

Me: Hey Zacharoony! (back to typing on my computer after smiling at him)


Zachary:  Did you know? I'm so smart, Mom. I really, really am.

Me:  (hands off computer, looking at him) Yes, I did know. You are smart, son.

Zachary:  And you know what?

Me: (still trying to type a little bit) What's that?

Zachary:  I even know what a mice is, Mommy.

Me:  A who?

Zachary:  (dancing like he has to pee) A mice, Mommy. A mice.


Me:  (fully typing because now I have no idea where this is going or how long it will go) Um, okay.

Zachary:  (really doing the pee-pee dance now) Do you know what it is?

Me: Know what what is? (one eye on him, one eye on laptop -- it's a skill,  I tell ya.)

Zachary: Mommy! A mice!

Me:  I'm not sure I know what A mice is. (stop typing and look at this scary pee dance and get serious) Hey. If you need to go potty go potty, son.

Zachary:  (ignores me, now squeezing his crotch and bouncing like Tigger) Mommy! A MICE!  A MICE is when it's a whole, whole bunch of MOUSES! (hands splayed like, "duuuhhh!")

*crickets* (fully have stopped typing)

Zachary: (beaming) Told you I was smart! Oooooohh. Okay, I gotta go peee-peeeeee.

(runs off to go pee, likely will miss the commode and make whole bathroom smell like gas station)

Me:  (yelling out toward the bathroom) Yaaaaassss! You sure are, son!


Wait--am I a horrible mom for telling y'all instead of correcting him? 

***
Happy Monday.

What was lost.

The old Manhattan skyline

"New York! Just like I pictured it! Skyscrapers and everything!"

~ Stevie Wonder in "Livin' for the City"

I watched a man telling his story of 9/11 tonight. He was a first responder--a proud fireman wearing a hat with FDNY across the front of it. He was also wearing oxygen.

Turns out that this gentleman rushed in to dig through that rubble from the first moments after those towers came tumbling down. The dust and debris that he was exposed to during those efforts led to respiratory failure.

"Masks? There wasn't no time for masks. We needed to find the people. The people who could be calling for us from under those bricks and mortar." He said that between wheezes with a thick and authentic New York accident. And something about the passion behind the way he said it suggested that he'd do it all over again.

That man required a lung transplant. A lung transplant. That lung transplant failed. And you know what? With all that digging over those weeks, he never found a single living soul.

I guess my first thought had always been those who lost loved ones that day. Watching him talking with those animated New York hands and unmistakable intonation interrupted by oxygen-dependent hacks  reminded me of all of the other things lost that day. He had lost his health--his ability to breath. Because he was trying to save at least one life.

Damn.

The downtown Atlanta Skyline

A few weeks ago I bought this poster at a festival of Atlanta's iconic places. Restaurants, parks, and all sorts of things were on it. It also had our skyline. That same skyline that made me gasp when I first moved near it and that has become a visual staple.  Our skyline has nothing on Manhattan's but I'd hate to see any part of it plucked away. It would be like being robbed of a part of what makes home feel like home. That makes me even sadder about how real, true New Yorkers must feel. Hell, I'm not even a real, true ATL-ien but my kids are. I thought of that as something that was lost that day.

Crazy.

Two summers ago, we went to D.C. to see Harry's best friend/Isaiah's godfather Shannon get promoted in the U.S. Army to Lieutenant Colonel. The ceremony was in The Pentagon and we took a tour of it that day. But before all that, it took an act of Congress to even get into the place and you damn near got tackled and tazed if you snapped a photo. Man. Everywhere you went there were service men and women.  Everywhere. Walking in that upright way that military folks do and whose faces were plastered all over the walls in every corridor. We learned that The Pentagon has always been that kind of place. Full of patriotism. Tightly secured. Inhabited by elite members of the armed forces.

That became my point of reference for The Pentagon. Men and women who are literally serving their country at some of the highest levels attainable on the military food chain working in a building that is supposed to be like a fort. I imagined the terror they and all of their family members must have felt that day to have that all breached. Remember? A plane crashed into that building on the morning of September 11, too. It's just as awful. We went into the 9/11 memorial in The Pentagon and even though our kids were small, we did our best to explain what happened. I felt ashamed because my mind always thinks "New York" and not "Pentagon" or "field in Pennsylvania" when I think of September 11.

But not any more.

Visiting with Uncle Shannon - Washington D.C. 2009

Shannon became Lt. Colonel Shannon that day, and we hugged and applauded and snapped pictures. The following year he was sent to Iraq for an entire year, separating him from his lovely wife and his two young children. A second grader who is now a third grader and a three year old who is now a four-year old. Separated from their patriarch. For an entire year.

Uncle Shannon with son Colin at The Pentagon

Our goddaughter Paige in the center at her daddy's promotion (with bffs)

Servicemen there in support of Lt. Colonel Shannon Jackson

With his committed wife, Michelle

What children miss when parents go to protect our country

See? Now I'm thinking, just maybe, if this all hadn't happened ten years ago today then, just maybe, Uncle Shannon wouldn't be gone away at all. His kids wouldn't be Skyping him on their birthdays or on the day before the first day of school. Just maybe.

So much was lost that day. So much. And today I am remembering those big things lost and also considering the little things lost in the chain reaction. Yeah. I'm remembering--with as much intention as I can. . . .

Because they all matter. They do.

***

No, thank you.

We were at the Waffle House a few days ago and the kind lady who was serving us passed the kids' plates over to us.  Each child had his own waffle, and on top of each waffle was a disposable one-serving cup of margarine.

"Oh, here," I said to her, "we don't need these, thanks." 

"No butter? On waffles? For the kids?"  The words came from her mouth before she could even stop them. I could tell that some part of her wished she hadn't said it. Partly because of her own rotund middle and ample arms that held our plates and partly because it probably isn't p.c. to go questioning how grown folks feed their kids. (At least to their faces, that is.)

I laughed and replied--careful not to be smug-health-nut-lady, "You know what? I'm trying my hardest not to even introduce butter to them. Weird, I know. It just seems like one of those things that, as yummy as it is, you can live without if you don't know about it. At least on waffles."

"That's smart," she responded with a genuine nod. "Makes sense." She put her hand on her hip and cocked her head to the side like she was thinking.

"My wife also doesn't like butter." Harry had to bust my bubble so I wouldn't look like super-save-a-kid-mom. Hater. But this is a true statement. I'm not a big butter fan. As a child I just didn't really "get" butter. Something about it looked like Crisco, which sort of grossed me out.

Funny, right?

But here's the thing.  Once I did actually taste butter, I did get it. I got why folks dug it so much and slathered it on top of their everything.  In fact, I even got the difference between real, sho' nuff butter and substitutes like Country Crock or I can't believe it's not butter (which I totally can believe isn't the real stuff.)  Yes. It's yummy. But what I learned from all those butter-less years is that a lot of things that call for butter are pretty damn delicious without it. Sure.  I make some very clear exceptions to being butter-free which are popcorn, yeast rolls, baked sweet potatoes, and corn-on-the-cob.  Oh, and grits. Yeah, grits. Otherwise, Harry is right--I'm cool when it comes to butter.

With this in mind, I started deciding which things I would and would not introduce my kids to on the table. I guess I'm looking for this happy medium between letting them live a little and not making them die from food addiction later. No. I'm not ultra-organic lady with puree'd baby foods and herbs on my window sill. Not that I don't wish I were that lady--I'm just not hard-wired like that.  Instead, I simply looked at a lot of foods and drinks and asked myself, "What if I never had this as a kid? Would I go crazy for it later or be fine to keep living without it? And would not having this intrude on what it's like to be a kid?"

Once I answered those questions, a few foods were relegated to being "foreign objects" to our kids.  This, of course, came from me and not Harry. Fortunately, though, he is down with it. 

And so. Butter made that list.  Now. Do they have butter with grandparents or at times when we're not in control? Probably. But are they looking for it at home or the 98% of the time they eat? Nope.  It's like they know that syrup goes on top of waffles but the butter part? No comprende.

A friend called me laughing fairly recently while Zachary was there for a playdate with her son. "Has your child ever tasted soda pop?" she cackled into the phone. 

"Actually? I don't think so."

All I could hear was hysterical laughter. "What? He's almost five!"

But, see, soda was also on that list.  I've yet to find anything about it that's good for you and, as a kid, there's such great alternatives to it.  If my kid has a soda at a birthday party do I flip out though? Naaah.

Gum.  That one, too.  Zachy had a stick of gum for the first time two weeks ago. And promptly swallowed it. Eh? It happens when you haven't had something.

I guess here is what I'm reflecting on today.  Kids and food and exercise and how complicated it all is. The Children's Healthcare of Atlanta organization has put out these very provocative commercials fighting childhood obesity. Georgia is the second most overweight state when it comes to children, and man. These folks are not holding back.  I was recently at a lecture that the CEO of CHOA (who is freakin' awesome, by the way) gave and she showed us a couple of these public service announcements. Check this out--oh and warning: these are very "in your face." People generally have strong reactions to them--some positive and some horrified. But their idea was to get people talking and thinking about childhood obesity and what we're doing to our kids one butter pat at a time. . . .





Well? What did you think? Me--I felt so sad seeing these commercials.  And even a little bit discouraged. Not because I don't think it's forward thinking and overall a good thing. I love that they are doing this and putting money into the fight against what has become a horrible epidemic. It still makes me feel sad, though. Because I know how complicated food and obesity are. I know how it is a culture in itself and how difficult it is to unravel culture.  I see this culture at work every day--and not just in the clinic or the wards. I see it in the break rooms and in the cafeteria on top of trays. I hear it in words spoken to employees in the lunch line like, "Would you like some fries with your burger?" or "You want sausage and gravy with these eggs?"

"Fries? Yes, please. No, wait. Give me some of them mojo potato wedges instead."

"I can give you both, sugar."

"Cool."

I used to live in a beautiful neighborhood in a predominantly minority part of town. It was clean and quiet-- and my neighbors were wonderful.  Yes. I meant to say quiet. No one running or walking or pushing a stroller in sight. Okay, maybe every blue moon. But for the most part? Nada.

Now I live in-town near the University. I can't pull out of my driveway without nearly mowing down a runner, jogger, or someone walking their dog. Bike riders and shirtless teenagers chatting and laughing on mile four. I even saw a kid from the boys' school running with her dad one day and I know for certain that she is in third grade.

Yeah.  It's a different culture in this neighborhood. And my old neighborhood wasn't a bad one, either. It just had a different vibe. . . .which wasn't as health conscious as this one. But it all has a domino effect, don't you think?

So Isaiah and Zachary are growing up with "exercise just for the hell of it" as a part of their culture. They're passing on the butter and asking why a drink with bubbles tastes so "spicy."  We're making some nights "fruit dessert" nights like my friend Lesley does with her kids and we're schlepping the kids to the gym with us to let them see that, yes, black folks run and jump for exercise and not only as a part of organized sports. But see, these were all choices that we made strategically. Oh, and did I mention? A whole lot of these choices cost money.  

Sigh.

I don't know.  Culture is such a hard thing to change. I don't know what those kids in those commercials are up against, either. But I do know this--a little can sure go a long way. So that's what I tell my patients at Grady. Try these little things that don't cost money. And do these things in front of your kids. Starting with simple ones like, "Butter? No, thank you."

Top Ten: Over Forty.

My birthday coffee!

Today is officially the twentieth anniversary of my twenty-first birthday. Okay and let's be clear about one thing--I am saying it this way only because I find it slightly amusing to do so. NOT because I am one of those people who is freaked out about it. In fact--quite the contrary.

Today I bring you the TOP TEN THINGS THAT MAKE BEING OVER FORTY GREAT.

10.

You no longer have to worry about turning forty. Especially when you're over forty. You've finally gotten used to telling people that you are forty by the time you turn forty-something which is pretty damn relaxing.

So in other words, not only are you over forty--by this point you're over forty, too. Let the church say amen!

9.

You aren't as broke as you were in your twenties. Well. You are, but it's a different kind of broke than that twenties-kind of broke.

8.

You have fully accepted that you are not in your twenties, therefore all of your points of reference change. Like, some folks in their thirties are still in denial about clothing, appropriate behaviors, etc. But, see, by the time you are over forty, you realize that there exists an ENTIRE generation of ADULTS who are younger than you and who have no idea what you are talking about with your pop culture references. So saying words like "foxy" and "sassy" and "sharp" work. And this is when people start having that nervous chuckle when you use too many "young" words like "OMG" and "BFF." This helps you to move on along to acting your damn age.

And that age is "grown."

7.

Although many of you thirty and twenty-somethings have the nerve to refer to yourselves as "grown," you are the only ones who think that. By the time you get to your forties, your grown-ness is no longer disputed.

Now.

This can be problematic for those living on couches or in Mama'nem's basements. It is glorious for those with lifestyles/life choices that Mama'nems don't approve of. Because, see, when you reach "grown" there is something about you and your choices that become not only your problem, but also your business. This, I like.

6.

Your goal for body image shifts from young Britney Spears to post-partum Britney Spears. Yes. Britney looks good these days. But no. She does not look like she looked when she was on the VMAs singing "I'm a Slave for You." That said, I could live with this version below. I sure could.

Oh and what's beautiful? Your man can live with it, too. It's lovely, I tell you.

5.

You get to tell somebody "because I said so, that's why!"

4.

Your friends have gray hair coming in, too. If you have premature gray that you color (like moi) you've been waiting for this moment. Now you can sit around and discuss semi-permanent versus permanent color and also when you plan to "hell, just let it go." You also talk about things like mummy-tummy woes after babies and whether or not you would be willing to let somebody aim a syringe and needle at your forehead if it meant less frown lines. You also discuss things like dammit, I'm not getting my tubes tied because, dammit, it's his turn to get something tied or snipped or fried. See? The conversations are just gnarly, I tell you.

3.

If you're lucky, you have a career. Not just a job. If you're lucky.

2.

You don't freak out when someone calls you "ma'am." (This precedes the age where you kick someone's ass for not calling you "ma'am.")

1.

You get to act all surprised and flattered when someone tells you that you CAN'T POSSIBLY be in your forties.

"Happy birthday, ma'am!"

"Thanks! The big four one!"

"Forty ONE? SHUT UP!!!"

"Yep. Born in 1970!"

"You don't look a DAY over thirty-nine!!!"

0_0

***

Happy Wednesday!

Thought I'd share my segment from FOX 5 today. . . not bad for a foxy forty-one year-old!

Housecall: Sjogren's Syndrome: MyFoxATLANTA.com

Redemption.

image credit

A few weeks ago I was talking to this woman who had gotten off of crack cocaine. It had been four full years since (to use her own words) she'd been "delivered from the stronghold" of addiction, and boy was she proud about it.

"I was out there bad," she said with a shake of her head. "But one day, I just woke up and looked around myself. This was rock bottom. I was flat on my back and all I could do was look up from there."

"Wow, that's awesome," I replied. "Did you go to a recovery program?"

"Nope." She lifted the cover to her breakfast tray and frowned. Covering it back up she looked back at me and smiled. "I prayed about it. Asked God to take that desire away from me. I knew that was the only way for me to do it."

"Hmmmm." I listened to her words and thought about this idea of this desire being "taken away from her." I cast my eyes over to the other members of my team, wondering how her description of drug abstinence was resonating with them.

"What do you mean by 'out there bad?'" one of the interns asked. We all swung our heads in his direction. I felt proud of him for asking this, even if it had broken my train of thought. I liked that he wanted to know more about her and especially her story.

She laughed and recanted, "You sure you old enough to hear all that?"

Our team shared her chuckle and waited for her to go on. "When I said 'out there bad' I'm talking bad as you can imagine. Turning tricks, robbing folks, doing whatever you got to do to get high. That's what a stronghold do to you. It make your mind crazy, like you can't make good decisions." She shrugged and removed the cover to the food again. Ripping open a salt packet she continued. "I feel so bad about that time in my life. But see, the last few years it's like I'm a new person. Like my life got handed back to me. When they test me for the AIDS and told me I didn't have no diseases, I couldn't believe it. That's when I knew I had a chance, you know? A real chance."

Something about her words immediately pushed tears into the front of my eyes. They began stinging like rubbing alcohol in a fresh wound; I tried my best to blink them away in the most inconspicuous way I could. She sighed and stuck her fork into the tepid eggs on her plate. Her mind seemed peaceful, as did her comfort with telling us all of that.

"Congratulations to you for getting your life back," I finally said. "I know you're so proud."

She nodded her head and smiled. "You know, doc? I ain't gon' even lie. I'm real proud."

And as I watched her eat her eggs my eyes became prickly again with fresh lacrimation. If she wasn't eating and if it wouldn't have seemed lame, I swear I would have hugged her right there in front of my entire team. Okay, I take that back--it was really that she was eating that stopped me.

Today I am reflecting on redemption. Redemption. I can barely type the word without crying. Damn. Here I go.

This is one of the main reasons why I love working at Grady. There is nothing that moves me deeper in my core than stories of redemption. They resonate with me so--not because I've had some hard life with tacks and splinters--but because I know that within us all dwells that need for a clean slate at some point in our lives. We need to have people see us with more than their eyes and to accept us not because we have straight teeth and straight spines or straight lives but instead just because.

I remember when I took care of a patient once who had an urgent surgical problem. The resident surgeons didn't agree with my assessment, yet I was senior to them. Instead of calling their attending physician, I shook my head and told the team that my patient would "eventually declare himself." He did just that--and subsequently needed an emergency operation after which he had a perioperative myocardial infarction (heart attack.) And then? He died. Yep. He died.

I deeply struggled with that experience. I wished in the hollows of my heart that I had fought harder for that man. That I had pointed my finger and said my piece and then stepped clear over their heads to get that patient the help he needed -- faster.

When I saw that man's son, he squeezed both of my hands hard at the same time and thanked me for all I had done for his father. And do you know what I did? I cried right there in front of him. It was as if he wrung those tears right out of me with that tight grip and I couldn't reel them back. Sure, it was probably unprofessional but there was nothing I could do to stop myself from the emotion. Partly because as a daughter and a mother I was sad that a man had lost his dad and a child had lost his granddad. But also because there was something about the way he took both of my hands into his during his deepest moment of grief to say those words that felt like redemption. Like they said, "Look, I know that you are a human but there was love in the care you gave my dad." Or even, "There is something complex about the expression on your face that is telling me you need this moment even more than me." And damn, I needed it. As selfish as it was, I did. And he gave it to me freely.

Imagine that.

Whew. Here I go again.

This is why I think I try to be accepting of all kinds of situations, you know? Like mostly because I know that I am way imperfect and needing somebody somewhere to just get me sometimes. It's why even though I'm a woman of deep faith, I don't spend time picking apart the parts of peoples' lives or even trying to relay what I think God thinks about what somebody else is doing. Besides, love and acceptance feel so much better than judgment and exclusion anyway, and frankly, it's the part that got me on board with my own spiritual relationship in the first place.

Anywho.

Even though that lady who'd abstained from crack for four whole years spoke of higher beings and deliverance from strongholds when giving her testimony, I know for sure that redemption comes in many forms. Sometimes it comes when you're lying on the ground and you finally realize that you can still look up. It also happens when a doctor looks across a table and casually tells you that, No, you aren't HIV positive. Other times it happens when someone takes your two hands in theirs and squeezes them tight. When for all intents and purposes you should be grabbing theirs.

I don't know.

I guess the most redeeming qualities come through every day acts like listening carefully and smiling genuinely and seeing people with more than just our eyes. Man. Every day I'm hoping someone does that for me and the people I love. I really am.

***
Happy Tuesday.

Now playing on my mental iPod. . . . .

Father knows best.

*no animals or patients were harmed during this post.

Overheard at the lake this weekend:

Zachary:  Daddy! I need to pee.


Daddy:  (looks over at me and then shrugs.) So go pee.

Zachary: You going to take me, Daddy?

Daddy:  Naww, man. Just hit that lake over there. (points at the lake--which is full o' people.)

Lawd.

Zachary:  Pee in the lake?

Daddy:  Yeah, man. Just walk on out into the water and. . . .aaaaahhhhhh. (demonstrates a gesture bordering on obscene and looks at me again.)

Zachary:  In the lake? With the fishes?

Daddy:  Where do you think they pee? Wait--you only have to pee, right? (cuts eyes back at me)

Zachary:  Just pee. Not boo-boo, Daddy.

Lawd. Lawd. Lawd.

Daddy:  Okay, then handle your biz. Hey--but be cool about it, man. Cool.

Zachary: Cool. (begins to try to look cool) Okay, Daddy!

Daddy: Zach--cool. Cool, man. Cool.


And after a big nod, off he goes. . . and coolly wades out into the lake front up to his knee caps. And then commences to. .  . . .SQUAT in the water for about fifteen seconds.  

Lawd.

Seriously? The most obvious pool or lake peeing incident of all time. Oh well. At least it wasn't as bad as the great Baby Ruth Pool Doody Incident on Caddyshack.

And just in case no one amongst the five trillion swimmers surrounding him realized what he was doing. . . .

"Aaaahhhhhh!"


Thanks, Harry.  You rock.

The man is full of wisdom, I tell you.

Time to talk.

It was time to talk to you. And I am so ashamed to admit that I had secretly dreaded this time. Not because of you, but mostly because it would be awkward and lumpy like it always is when the doctors can't speak your language. The thing is that usually even when "the doctors" aren't fluent in someone's native tongue, somebody somewhere in the vastness of the hospital is. A crafty student or resident finds that person and just like a combination lock that finally had the right code entered, everything is opened to us.

But not this day. There isn't that person lurking on the Mother-Baby unit or at some desk down in the Emergency department. No person from your home country willing to change your words from a plume of smoke floating from your lips to crystal clear images that paint a picture and explain why your face has that twisted snarl of pain. Not even someone from your family to rush in after work still in uniform and waiting with anxious eyes on the end of the page the nurse just sent to the team.

Nope. Not even one.

So for this reason, I wasn't looking forward to this time on rounds when I needed to see you. My eyes quickly trampled over the clock hanging on the ward--4:45 p.m. Afterschool care pick up in the horizon and yes, I know, this was my problem not yours. But this problem of mine was making me even less excited to hear about yours. Especially because my 5:20 deadline would unfortunately become yours.

The medical student was perched beside the door waiting.

"You ready, Dr. M?" he asked all bright-eyed and bushy-tailed.

"Yep!" I announced with as much spunk as I could muster. But inside I was saying, No. I am not.

We approach your bed and find you curled in the fetal position. Your eyes squeezed shut and a tsk-ing sound is the first thing you say in response to my pseudo-chipper greeting in English. My patience drains down into my feet and forms into a puddle on the floor. I don't speak "tsk-tsk" and you don't speak "pseudo-chipper."

"We can use the phone interpreter," the student offered.

He must have stepped into that puddle and had decided to have patience for us both. I would need it.

"Oh, that's good," I replied, "so, we have a phone interpreter that speaks this language?"

"Sure do," he answered in a real-chipper that wasn't pseudo like mine. "I used it earlier."

He smiled gently at you and picked up the bedside phone. Looking at a laminated card retrieved from his overstuffed medical student pocket, he dialed a number and entered a few codes. I could hear a muffled voice and he announced your language in response. And then we waited.

"Looks like we're in queue," the student said while still being careful to keep including you. He held your hand and patted it. "There aren't many interpreters speaking this language, so sometimes there's a wait."

Of course. A wait. A wait to have a perforated discussion with you between a tiny voice coming through a hospital telephone, a medical student who already had spoken to you, and me--who still needed to get her two children from school before six p.m. That pool of patience floated out of the door and down the hall.

I rubbed my neck hard which is always what I do when my patience wanes. And then, finally, an interpreter.

"Hello, my name is Dr. Manning and I'm the senior physician that will be caring for you with the team."


I announce this into the telephone and pass the receiver over to you. The muffled voice says a version of my greeting and you mumble something in return.


"She says, 'Good to meet you, madam.'" Which was little surprising because the look on your face didn't seem to say that. It looked angry and tired and like it wasn't down with any pleasantries such as 'glad to meet you' and damn sure not 'madam.'

"Tell me about your pain that you've been having." I extend my arm back toward you with the phone. This time your answer is longer with more "tsks" peppered throughout. I realize that the "tsk" is not a good thing; mostly a sound of frustration. I wanted to "tsk" too.

I learn of your pain. The student interjects and fills in blanks about your very complicated past medical history. We lay the phone receiver down and examine you, picking it up to ask things like, "Right here?" or "What about this?" Between the student, the telephone interpreter, and your tsks it comes together. The diagnosis isn't a good one. In fact, it is a bad one. A really bad one.

Now what next? Tell you of a life-threatening, life-abbreviating diagnosis through a choppy back and forth via telephone? Do I do this, knowing that no matter how nice that tele-interpreter man sounds over the phone that he can't see your facial expressions or know exactly when to soften his intonation? Even in the King's English it's no walk in the park to tell someone that, "Oh this diagnosis that you have? Well it's essentially trying very hard to shorten your life. And we don't have a lot of medicines to stop what it's trying to do to your body." Yes, this sucks. How do I tell you something like this under these circumstances?

I look at the student and he looks at me. And a decision must be made about you. Tell you all of this or no? Right then, right there I decide.

"Do you have any family at all who speak your language here in Atlanta? Any one that you know that can come and help? There are so many complicated things to talk about. Some hard things. We would rather not have this conversation over the phone."

No. This wasn't the time.

I stick my hand in my lab coat pocket and secretly cross my fingers. Someone has to help me with you. Not a mystery man inside of a phone but a real person with warm blood and three dimensions.

I put the phone to my ear and what I hear washes me with relief.

"She says that she has a son. He can come tomorrow. After work to speak with the team."

Yes.

We exchange a few more words with you, the tiny voice, and your pain. We confirm that you are comfortable right now and make a plan to meet with your son. And you nod when the tiny voice tells you this through the phone.


I turn the ignition in my car at 5:18 p.m. Life goes on and surely I will find kids covered with Georgia dusty red clay and unidentified stickiness on their cheeks. Full of the vigor and joy of life and safety and consistency and familiarity. Then, I think of your frail body, the disjointed communication, and the worst part of it all--the fact that you are dying. In this foreign land with its confusing culture and impatient people whose cell phones play music and whose wall-phones are bilingual, you are dying.

And here I was worried about me and my time.

"Tsk," I say aloud to myself. "Tsk tsk."

***

Now playing on my mental iPod. . . .