Teenage Mutant Target Checkout Chick.

(*Disclaimer: Any likeness or similarity to you, your local Target or anything that would incriminate me is purely a coincidence. Yup. Sure is.)

"I found it hard, it's hard to find

Oh well, whatever, nevermind"

~ from Nirvana "Smells Like Teen Spirit"

Okay, so recently I was up in Target (which is not an unusual thing at all.) This was not a "regular" Target run--you know the kind where you go for ziplock baggies but come out with some "jeggings" and an "infinity scarf."  Nope.  I was on a clear mission:  to purchase a gift card.

Simple enough, right?

A friend and fellow Grady doctor had a baby recently and we had taken up a collection for a gift from a few colleagues. Due to the craziness of my schedule, I hadn't gotten around to picking up the gift card until this particular day.

Alright, so check it. I pull up at Target. I sit in my car in the parking lot and (kind of stupidly, now that I think of it) count out all of the cash two times which is, literally, in fives, tens and the occasional twenty since most people gave what was conveniently in their white coat pockets that day.  So I confirm the amount in small bills: $300.  (read: three hundred bucks.)

I go into Target with said $300 in a ratty envelope in my purse looking like someone going to get her lights turned back on. I get in the line and wait my turn.

There she stood. Smacking her bubble gum with eyes half mast. Her. The Teenage Mutant Target Checkout Chick. She looked absolutely bored with her job and life in general. No older than nineteen and with a mantra that was surely the opposite of "the customer is always first."

Since there were two people ahead of me, I studied her.  Two-toned hair--dark at the roots for nearly three inches--followed by an unnatural auburn color that appeared to have come from a box in that very store. Overplucked eyebrows that made her look older than her age but a forehead smattered with acne giving away her proximity to adolescence. Facial piercings -- one just above her chin and below her bottom lip, one on the right side above her top lip and one on her eyebrow--with some kind of crustiness around them that made me want to accost her with a cotton ball and some hydrogen peroxide. (Seriously.) Nails bitten to nubs and forearms with elaborate cursive tattoos with names that I can't make out. Yes. The teenage mutant Target checkout chick.

 Now. Let's be clear. It wasn't her piercings or her tattoos that irked me. It was her blah attitude and lack of . . .urgency. . .that annoyed me.  Absolutely annoyed me. People kept talking to her, greeting her, and offering her all kind of pleasantries but she had nothin'.  Nothin' whatsoever.

The man ahead of me was chipper enough and determined to get her to awaken from her blah-ness. A pleasant elder with graying hair and lovely twinkle in his eye comparable to that of Santa Claus himself. And just maybe he was whistling the Andy Griffith theme song. Just maybe.

"Hello there! How are you today, young lady?" His voice was kind of sing-songy. So sweet and innocent.

The teenage-mutant Target checkout chick mumbled something like "mmm alright" but not even in a way that should qualify as real words. And this man was an elder, too, and y'all know how I feel about the elders. I could feel my fist balling up. He went on-- totally oblivious to her, "Oh, wait, wait. . . I have my own bags right here! No need for the plastic!" He handed her the bags he'd brought cheerfully. Then he just stood there and beamed in her direction, like someone trying to melt icicles with a heat source. It wasn't working.

And do you know what TMTCC did next? Do you?? This child lifted the plastic bag right into his reusable Trader Joe's bag. Yes, she did!! And then--like she hadn't just done something completely uncool--commenced to bag the rest of his razors and soap in his other Whole Foods bag.

Awww hell naw!!

But the nice elder-dude was too nice to even flinch. You could tell the love of Jesus or Buddha or somebody was all up in him. He was still human, though. He clenched his jaw a bit--I think because he was a really green dude and was appalled by the plastic--but he kept on smiling.

Me on the other hand? I was thinking, "Aww hell naww!"  But y'all would be proud of me. I stayed in my lane. Sure did.

"Did you nab that in store coupon on the razors for me?" Mr. Chipper asked. He was determined to wake her up. And get his fifty cents off the Gillettes.  She responded with a slight raise of her eyebrows and that's it. No words, no nada.  I guess it was her way of saying. . . actually I have no idea what it was her way of saying. In my neighborhood growing up, it looked like the look that gets somebody sucker punched. But that's Inglewood, California and not suburban Atlanta, so I don't know what the hell that was about. All I know is that she probably shouldn't look at anyone like that if she goes to Inglewood. . .or if she finds herself some choice parts of Atlanta. Mr. Chipper peered at her register to see if he had gotten the coupon. Still all pleasant-like.

She muttered again. And whatever she muttered meant that he wasn't nabbing any "in store savings" and neither was she. He let that ride, too. No protest, no nothing. Talk about turning the other cheek, man! He took the high road but I saw that masseter in his jaw popping out again as he tried to keep down his Inglewood reflex from smacking her across her teenage mutant Target face.

So me? I'm watching all of this and thinking, "Aww hell naw."  And as I inch up to the counter, I decide to be cool (not nice cool, but cool cool) with her in pseudo-solidarity with Mr. Chipper. I don't even say hello. I just step up and look back at her with an ice grill stare--half mast, no less. Why? I do not know. It just seems like a way to right the universe again.

I lay the gift card down in front of her like a bank robber note and tell her, "I need to get a gift card."

"How much?" she sputters nearly inaudibly.

"Three hundred," I reply.  I didn't even say dollars. That would have been more than she deserved after her treatment of Mr. Chipper. Mmmm hmmm.

She turned and punched that in without another word. Three hundred dollars. And so. I reach in my purse for the ratty envelope and take out the cash. Right there in front of her on the conveyor belt, I count the money. Out loud.  I scoop it up and count it once more. Then I hand the stack to her, smoothing out the edges best I can (though she doesn't deserve it.)

"Here you go," I say.

She takes the cash and begins quasi-counting it into the drawer. I realize that she hasn't really pre-counted it or anything, and that her system seems mad faulty. This is not my problem or my care at this point so I just shrug and watch.  Until she finally looks up at me and says this:

"This two eighty. You short twenty."

I furrow my brow and pulled back my neck full sista-girl style.  Hand on hip, backbone surely about to slip.  "Uuuuh, I don't think so. I gave you three hundred dollars cash. I'm sure of it."

She curled her lips and gave a tiny shake of her head. Kind of like the way she looked at Mr. Chipper with that in store coupon. Like, no and that's the end of that.

But, see, I wasn't Mr. Chipper.

So there we were. Me with my hand on my hip, neck fully prepared to roll, and index finger ready to wave from side to side like a windshield wiper. . .and her with her face full of piercings, bitter-beer facial expression and exaggerated eye-rolling. It was on.

"Well," she finally said still with that surly smirk that would make me say to my own kids--"YOU BETTA FIX THAT FACE!"--she said, "You might have miscounted or something."

I fired back with the one two punch--quick like Money Mayweather. "Or maybe you were so busy having that ol' funky attitude of yours that you miscounted."

Gasp. Yes. I really said that. Zero exaggeration.

"Mmmm."  That's all she said. Mmmm.  And that's it. That's when I looked from side to side to make sure that this eighteen-nineteen year-old TOPS girl realized that she was standing directly in front of a grown a-- woman and not one of her homegirls.  I had her "Mmmm" alright.

I think a tumbleweed rolled by as we stood there facing off. I looked her up and down--you know--in that way folks do right before a fight after school on the playground and then I told her,"Oh, well sweetheart you gonna have to recount it then."  And yes. I meant to say YOU GONNA and not YOU'RE GOING TO because that was exactly how I was feeling. And yes, that "sweetheart" was meant to be passive-aggressive because nothing about her behavior warranted such a term of endearment. And because--EPIC FAIL on her part-- I knew she had already placed all of the cash into the drawer and could not do a recount no matter how hard she tried.

"Recount? I can't recount it," she replied with a hint of pleading in her voice which I totally caught.

The empathic geek in me felt a teeny bit sorry for her then. Just a teeny bit. Not so sorry that I was about to give her twenty dollars, though. Oh hells no.

Then she realized how she sounded and decided to shake off the wimpy pleading voice. . . . and get gangster with me. Just then another tumbleweed rolled by. "Well, I don't know what to tell you. You only gave me two eighty, so oh well."

Whaaat?

"Oh, but I know exactly what to tell you. I'm telling you that you're about to give me this three hundred dollar gift card unless you want me to get a manager over here. And if that's what you want, then fine. I'll have them check the film--'cause I know y'all are filming--and that's when your store manager will see how you stuck that plastic bag in that man's Trader Joe's bag!"

(Sorry. I stayed in my lane as long as I could.)

"Whaaat?" she exclaimed in a puzzled way that said, like, What are you even talking about?! Because she didn't even realize how FOUL it was to put plastic in a Trader Joe's bag nor had she even noticed the kind man who'd just been in front of her. She stared at me like I was crazy but I didn't care. I didn't like how she treated Mr. Chipper so she had it coming.

That's when she folded her arms and asked me what I wanted to do. Still trying to face off--this time with a sort of gangster unilateral eyebrow raise-- and now with even more tumbleweeds rolling by.

Seriously? Seriously.

See? Why'd she have to get gangster with me? Like NeNe on the Atlanta Housewives says, "You come for me, boo, I'm gon' come for you!" And so. That's exactly what I did.

"It's like a Dig 'em smack. . . you smack me and I smack you back."

~ EPMD "You A Customer"

"Oh baby, you in a bad way. Unless you recount that money, you definitely in a bad way."  Yep. That's exactly what I told her. And YES. I meant to say YOU in a bad way not YOU'RE in a bad way because that phrase is not meant to be grammatically correct.

Which reminds me: Telling someone that they're "in a bad way" is quite similar to telling them they're S.O.L. If you don't know what "S.O.L." means, I suggest you Google it--the answer is the first hit. Anyways, the teenage mutant Target Checkout Chick was 100% hip to that lingo and didn't appreciate my suggestion. So I made sure I made myself clear. "Oh, you in a bad way if you think I'm giving you another twenty bucks, babygirl. Forget it."

And yes. "Babygirl" was warranted, too.

She stared at me, kind of dazed-like and like I wasn't serious. But then regrouped and fixed her face when it became very clear that I was totally serious.  That's when she slid the card over to me and let out this super-duper-sixth-grade-sounding, ultra-extra-exasperated teeth sucking noise coupled with what I am 76% certain was the less kind descriptor of a female dog.

No she di'in't! 

I took a deep breath and reminded myself that I was a grown a--woman and that fights in this age-group are referred to as "assaults." Man oh man! I could smell her funky attitude at this point and her even funkier teen spirit which-- when it's translating to disrespecting elders-- is not so fragrant at all.

Yeah. So that kind of annoyed me all over again.

"Look here! Do you know how many people would kill for this job? Do you? I work at Grady Hospital and I have patients that would step right into your spot in a heartbeat and do this job with a smile! But all you can do is stand up in here with that funky look on your face and that funky attitude like YOU the customer!" And yes. I meant to say YOU the customer, not YOU'RE the customer because that was where I was at the moment.

She stared at me like I was a crazy old lady, which made me even madder.

Finally her eyes narrowed and mine narrowed right back, and since I'm a mama, mine won.

A lady behind me was snickering and she looked at me and said, "Girrrl, you betta tell it!" This seemed to make steam come from TMTCC's ears and make her bitter-beer face twist up even more.

I couldn't take it any more so I scooped up my gift card, spun on my heel and shot her an exaggerated "peace out" sign over my shoulder as I walked away--grown woman purse on my shoulder, switching my post-partum hips and with my grown woman high heels clicking on the slick floor.

(Okay, okay. Maybe I didn't chuck her a deuce sign, but admit it--that did add to the imagery didn't it?)

But seriously. . . . you wanna know what I DID do? You better believe I stopped at the gift kiosk on the way out to confirm the amount on my gift card. . . . . 

Three hundred dollars, baby!


Mmmm hmmm.

The point of this story? None whatsoever. But I'm wondering. What would y'all have done? Would you have taken the high road and have just given her the $20 and kept it moving? Harry was mad I didn't actually get a manager but I had to go to back to work. He didn't care about that and said he would have just had to be late. Another friend said, "I would have just given her the twenty bucks." Maaaan, please.

Weigh in, y'all.


***
Happy Tuesday. (This was on my-hand-me-down super-old MacBook from my Mom--the old white one with the two inch screen! That's okay though! It woke up for the job! Woo hoo!)


Now playing on my mental iPod. . . Smells like Teen Spirit by Nirvana


 and also this. . . . EPMD "You a Customer." (Especially for Neil W.)

MacBook NO!

The unthinkable has happened. My almost six year-old MacBook Pro has died. Okay, maybe not died yet, but it appears to be in some kind of coma that isn't easily reversible.

Yes.

Now, some of you who must write to stay alive (like me) are having a panic attack on my behalf. And to that I say thank you for your empathy.

When, you ask? It was yesterday. Unexpectedly, too. Like some cruel lover who seems fine one day but wakes up the next and says, "It's, like, over." To which you say, "Excuse me? Did I hear you wrong?" (Which, in this instance, was several attempts to force a restart only to be teased with an apple and a swirling spinner then have my hopes dashed by a blink and then the scary gray nothingness you see above.)

So I well up with tears and plead with my lover-slash-MacBook Pro, "After all we've been through? I mean, didn't I, like, refurbish you after that red wine incident? I mean, it's not like that was even my fault, either!"

And the MacDaddy just stares back at me with a gray blank indifference that boils my blood. So then I lose my cool.

"You should have told me you would do this last summer when I was replacing your hard drive, you a--hole!"

Again, nothing.

So yes. My MacBook Pro has done what I thought was only relegated to crappy Dells. It did what would surely make Steve Jobs himself turn over in his grave. It. . . it. . . stopped working. Or at least it faded to black.. . .I mean gray.

Deep breath.

What does this mean to me as a blogger? It means I have spent the last 24 hours trembling in a corner rocking back and forth, that's what it means. It means that I have just tortured myself by blogging on a tablet touch keyboard because that fix. . . oh man. . . I had to have it. Man. It also means that unless I come up with a plan B, I will either be iPhone and iPadding it or not posting much.

Oh, what's that you said? Why not just go buy a new one? Uuuuhhh, because first of all, I am a mother of two small kids and it's almost Christmas and also Mac Books cannot be found in the Target dollar bin. AND. Clearly, (since obviously I can be a little. . . errr. . . thrifty) I fully intend to see if my almost six year-old MacDaddy can be resuscitated before I do anything drastic. Like get another one. Duh! (Unless, of course, my dad gets a new MacBook and let's me get his old one. . . .hint hint.)

Woe is me.

Hey. That reminds me. Are any of y'all old enough to remember when the early generation Mac notebooks would give you the "Sad Mac" face when it had bugs? That's when you knew it was a wrap for sure! At least I didn't get that. (I tried to put a picture of one in this post but couldn't figure out how to do it from this ultra-craptacular iPad Blogger app.)

Woe is me, again.

Okay. So here is the point where you shower me with all sorts of sympathetic commentary. That or a coupon for a new MacBook Pro. (Um, yeah. I'm thinking the comments will cost you less.)

The "Sad Mac" used to literally appear on your screen!

Oh. Guess I did figure the "Sad Mac" picture out on the BlogPress app after all. (I'm still sad, though.)

***

- Posted using BlogPress from my iPad

Moving Right Along.

"Movin' right along
Footloose and fancy-free
Getting there is half the fun; come share it with me
Moving right along (doog-a-doon doog-a-doon)
We'll learn to share the load
We don't need a map to keep this show on the road. . . ."

~ from The (original) Muppets Movie 

Small group "alpha" was the first small group of medical students I've ever had. I met them in July of 2007--their very first day of medical school. Nearly all of them were strangers to one another, and 100% of them were strangers to me. Countless hours, teaching sessions, laughs, tears and conversations later that has all changed. Now they are family. . .to each other and of course, to me.

Before I knew it, 2007 had become 2011 and they all flew from the nest last year. Six to start their internships and one who took a quick detour to get a Masters of Public Health before heading out to do the same.

My how time flies! It's hard to believe that I have two other small groups now and that I've been on the Emory faculty for a full decade. It's even harder to believe that I started my first day of medical school over twenty years ago! Yep, hard to imagine, but absolutely true.

Although I remember my internship vividly, I often wish I had more snapshots from my intern year. As a matter of fact, I'm pretty certain that I only have one, and actually I don't even know where that one is any more.  Anyways. When it comes to the medical students, I've had plenty of picture chronicling their journey through school. The mama in me has enjoyed sifting through photographs of my small groups. . .starting from that first year and all through the three that follow.  It's fun seeing the growth. But internship is different. You get busy and rarely take pictures--and pretty much never take them on call or in clinical settings or anywhere for that matter. For that reason, I ask my recent graduates to periodically check in with me. . . .via phone. . .email. . .text whatever. . . . but especially I say to them, "Send me a photo. I want to see what you're up to."  Mostly because I want to see their faces and inspect them in that way that mama birds do. And also because I want them to have a collection of photographs of themselves from the year when its over. I bet they'll appreciate it someday.

Well, here they all are this week. All seven not-so-baby birds--the firstborns of the small group family-- checking in at the nest once again. . . .much to my delight. From San Francisco, Saint Louis, Chicago, Detroit, Washington D.C., Boston, and one whose face I get to see occasionally right here in Atlanta. Here they are. Moving right along. And from what I see, they are more than okay. They are great.

Antoinette:  She's back from research experience in Guatemala and now interviewing for residency programs in OB/Gyn.  This shot was taken in Boston which I'm guessing must have been pretty darn chilly from the coat. It's been exciting to see her seeking out her next chapter.

 Hreem:  Still smiling in her Chicago-based internship. This month? Neurology. Ultimately? A life of Ophthalmology. If my kids need Lasik, she had better hook a sister up.

Jin:  I'm impressed by any intern who can still hold up a victory sign on the Medical Intensive Care Unit rotation. Per her last text five minutes ago, she is "enjoying herself."  I suppose it makes sense for a future anesthesiologist to dig the ICU.  Living in Washington D.C. probably helps, too.

Tony:  If this picture suggests that this guy is hilarious, it's because he is. This future otolaryngologist (also known to regular folk as the EAR-NOSE-and-THROAT doctor) is blasting mucous out of nostrils in the Motor City. He's extra happy this month because instead of doing the myriad of other rotations that most interns do before getting the show on the road, this month he's actually working in his chosen field. Here he is with the scope in his hands, fronting like he's not a novice. Mmmm hmmmm.

 Doug:  All smiles on his no-call Primary Care month.  Spending time with his lovely wife and their two pugs.  Just came off of the ICU which, like Jin, he also enjoyed.  Explained again by a future in Anesthesiology.  Lucky me, Doug is actually an intern in the program I direct here at Emory. I just saw him Thursday and got to hug his neck. Next year, that will be harder since he'll be heading up to NYC to start the advanced program in Anesthesia. :(

 Alanna:  I certainly don't recall looking this good on my night float months! But then, I also wasn't doing my residency in San Francisco, either.  She describes her fellow interns as great and seems happy there.  Plus Alanna's husband, Luke, is amazing and supportive--something else I didn't have the slightest idea about when I was an intern.

Sparky:  Adam just finished up a month of wards at the VA Hospital in St. Louis. He couldn't wait to actually get to "do something" -- which has made his rigorous internship a joy for him so far. It made me happy to see him taking a moment to unwind.  And seeing as the dude behind him is wearing shorts. . .it must be warmer in St. Louis than it is in Boston.

Me:  Had a glorious morning teaching Small Group Gamma (class of 2015) in the med school, went back to Grady for a while and closed out the afternoon spending some wonderful time with members of Small Group Beta (class of 2013) -- right on my couch in my own house.  After that, I went to get my kids, came home and popped a gigantic bowl of "real" popcorn. We hung out and watched "Charlie Brown's Thanksgiving Special."

Life is good.  

***

"Movin' right along,
We've found a life on the highway
And your way is my way,
So trust my navigation

Movin' right along (doog-a-doon doog-a-doon).
You take it, you know best
Hey, I've never seen the sun come up in the West?"

***
Now playing on my mental iPod. . . "Moving right along" from The (original) Muppet Movie

I won't complain.

The original Grady Hospital (now Human Resources)

Working at Grady is like working in another little special country sometimes. There are things that are part of our normal here that in other places would seem odd or unusual. These are the things that make me love working at Grady so much.

On Monday the clinic was pretty busy. We finally wrapped up the last patient for that session, and at about 12:40, I sprinted down the stairwell and trucked through the hall on my way to get some food. I had only twenty minutes before being expected back so my brisk walk turned into a jog.  I waved to passersby and chuckled when a gentleman said in that very Grady way "Don't run nobody over, Doc!"

Purse on my shoulder, white coat on and heels clicking on the linoleum. . . .in quest of the Monday special at Subway and hoping the line wouldn't be horrible when I got there.  Just as I reached the E elevator area which is just before my turn to get out of the door, I heard something that made me slow down.

What is that?

I furrowed my brow, stood still and listened for a moment. That's when I figured it out. It was the voice of an aged male. . . singing at the TOP of his lungs. And weirdly it wasn't at the TOP of his lungs in a mentally ill or obnoxious way, either. It was in this way that seemed reminiscent of what it must have been like for folks picking cotton out in fields or scrubbing their floors on Saturdays. Not a performance type voice either. Just this loud and proud and unashamed voice bellowing out a Negro spiritual. . . .


"I HAD SOME GOOD DAYS 
I HAD SOME HILLS TO CLIMB 
I HAD SOME WEARY DAYS
AND SOME SLEEPLESS NIGHTS...."

I eased toward where the voice was coming from and laid eyes on the singer--an elderly African-American man appearing to be nearing his ninth decade. He was holding a cane and coat over his arm, and had simply decided to close his eyes, throw his head back and break out in song while waiting for the Grady elevator.

There were easily twenty people waiting in the vestibule with him. And you know what? None of them seemed the least bit fazed by this occurrence. Not the least bit.  In fact, several of them offered shouts of praise -- not to him per se, but those shouts that you hear in black churches after the first few stanzas of any gospel song-- meant not for the singer but technically for God.

He kept going in his wobbly voice:

BUT WHEN I LOOK AROUND
A-A-AND I THANK THANGS OVER. . . . .
ALL OF MY GOOD DAYS. . . .
OUTWEIGH MY BAD DAYS. . .
I WON'T COMPLAIN!!!"

I smiled as I watched,  taking it all in.  Then something even GRADY-er happened.  A woman that appeared to be no more than five years older or younger than this man JOINS IN with him. Yes! Joins in singing the same song equally as loud has he!  And they didn't even appear to know each other! She just came up beside him, lifting one hand to the heavens and not even really looking at him. But she was on his page most definitely. . . .her gravelly voice belting out through the corridor in that same unabashed tone. . .still punctuated by shouts of affirmation from others nearby.

And so in unison they continued:

"SOMETIIIIMES THE CLOUDS HANG LOW
I CAN HARDLY SEE THE ROAD
I ASK THE QUESTION LORD,
'LOOOORRRD. . . WHY??? SO MUCH PAIN???'
BUT HE KNOW WHAT'S BEST FOR ME
ALTHOUGH MY WEARY EYES THEY CAN'T SEE
SO I'LL JUST SAY, 'THANK YOU, LORD.'
I WON'T COMPLAIN!!!"

It was absolutely beautiful.  Beautiful on so many levels, I tell you. Beautiful for me because, yes, I'm a believer, but beautiful beyond that, too. Here were two strangers -- both African-American elders -- who had surely lived through being spit at, called "boy" or "gal" and "nigger" or "nigra" and referred to collectively as "coloreds."  Who, if they were Georgians, had lived through a gubernatorial campaign with the motto "NO! NOT ONE!" for the leading candidate who promised to never let one--NO!Not one!--black child integrate a school in Georgia. (That candidate won by a landslide.)

They knew of a "White Grady" and a "Colored Grady" . . . a world with air conditioning on one side and open windows with flies and sweltering temperatures on the other.  Told that one of them equaled 2/3 a man and for this reason stood in protest with signs pleading with the world what should have been evident -- "I AM A MAN." They sat in the backs of buses and entered through back entrances. Withstood teenage boys with pink twisted snarls speaking to them like they were children just because of some false superiority in their skin color. Forced to say yes'm or no'suh to these same KIDS, despite the fact that they were young enough to be put over a knee. Or worse withstood poisonous words from the mouths of young adults that they themselves had raised.

And yet. Despite all of that, here they stood.  Strangers. Singing. . .still singing from the depths of their guts these simple words:

"I won't complain."

I didn't cry then. At the time it hadn't fully sunk in so I just smiled and then went on my way. But later on as I was driving home I thought about what they were singing and the sincerity in it. I let it sink in. . . the entire scene. . . . .and I did cry. Man, every time I imagined them and what they must have seen in their lifetimes more tears came. I felt so indebted to them.

Then I cried some more, feeling ashamed for the things I'd complained about that very day.

Yeah.

This? This is Grady.

***
Happy Wednesday.


Now playing on my mental iPod. . . the EXACT version of the song they were singing that day. . .

Duty Hours Pre-Form Part 3: Panic! At the NICU.

*Names and details changed to protect anonymity. . . you know the deal. . .

image credit - premature baby in NICU

By the time I reached my final year of residency, very little scared me.  As a fourth year veteran in a combined Internal Medicine and Pediatrics residency, I had faced my share of medical emergencies and had weathered some substantial storms.  My training took place in the 90's, so none of this medical experience was limited or abbreviated by the need to scurry out of the hospital to adhere to duty hours restrictions.  So by that last year? Chile, please.  My motto was (with a dust of my shoulders) "Bring it on."

Every three months we alternated between rotations in the Pediatrics department and the department of Medicine. In the first two years of training, those "switch months" were terrifying. As an intern, that first change over in October landed you squarely in a foreign land, kind of like a new kid in school that started three months late.  You'd be asking dumb questions about fluids in infants or trying to calculate dosages per kilo in 175 pound adults.  Not cool.  The second year was tricky, too, because it was punctuated by a belated introduction into the supervisory role.  All of your classmates in the un-combined programs had already gotten a six month jump on you, so here you were fumbling with finding your mojo as your interns gave you a hairy eyeball. It was just as rough as it sounds.

But then came fourth year. That glorious fourth year.  You were now the "super senior" and big man/woman on campus. . . the person they woke up late at night to get the impossible procedures . . .the one that incited cheers from trembling interns when they discovered that it would be you bringing all of your mojo to their night on call.  Yeah, baby.

One night in the late fall during my fourth year, I was the senior resident on call in the neonatal intensive care unit (NICU.)  The NICU at this particular hospital was a level III which meant that, with the exception of complicated surgical needs, most of the medically complex babies born at our facility stayed right there. There was no life flight helicopters to rescue us from the sickest of the sick or the tiniest of the premature.  And although I said that very little scared me by this point, a rough night in the NICU was the one thing that absolutely did. Scared the absolute crap out of me.

Babies. There's just something about babies that haven't lived their lives yet and the parents who are counting on you to do everything that always kept butterflies in my stomach all night long whenever I was there. We carried this pager called the "code pink" pager when we were on call. No, it wasn't pink or anything, but it did scream like a banshee whenever some mama was delivering a baby with any inkling of a potential complication.

Most times it was simple stuff. The cesarean sections were the easiest of all -- baby with a big head that wouldn't pass through mama's narrow pelvis. C-sections always got us called just to be on the safe side. Fortunately, all that meant was chuckles with the anesthesia team, smiles with the nurses and coos at the new baby who'd just been lifted out of a bikini incision.  My favorite part was seeing the mama's face when someone showed her the baby.  I liked being that someone, so usually leaped at the chance to swaddle the little pumpkin and whisk it over to the other side of the blue curtain as the proud papa smiled too.

The meconium-stained amniotic fluid calls were more complicated. You could arrive to a baby in major respiratory distress or find a bouncing baby with nothing but stained finger nails. Meconium is the fancy name for the poo that the fetus is supposed to hold until after the big arrival.  If the baby is under some stress, like infection or some issue with mama's health, they let it go in utero. When the water breaks, that greenish fluid signals the OB to call us for back up--and to get that baby out of there quick.

Then there were the premature deliveries. Those dear, dear mothers sitting in bed strapped to a monitor and praying to God that the baby wouldn't come out.  In these cases, we would follow our attending and fellow into the room and speak with the mom about what to expect. Mom would get steroids to help the baby's lungs to speed up at maturing while the high risk OB team would do all they could to keep the fetus in mom as long as possible. But in the times where the delivery was inevitable, for the most part we were ready.  Ventilators and infant warmers rearing to go and bad ass NICU nurses ready to pounce on that baby until it was medically copastetic.

This night we'd hustled over to a few c-sections and one or two meconium fluid deliveries. At least one of those babies had some complications, so it required us to put in lines and figure out the ventilator settings. We got that baby stabilized and later we admitted a 29 1/2 week preemie that, other than being a little on the small side, was doing fabulous. Combine this with the babies already in the NICU and our hands were full. Even though all of these things had us hopping, for the most part, it wasn't too bad of a night. And even better, the neonatal ICU fellow on call with me--Shanthi--was one that I trusted. She was smart and organized and not the the least bit lazy. All was well with the world. Especially since I had her with me in the one place in the hospital that challenged my sphincter control.

It was after midnight and finally things were slowing down in the unit. "Let's get some sleep while the getting is good," said Shanthi in her melodic Indian-slash-British-tinged accent. "You guys go to bed."

"No, Shanthi, I'll stay in here and crash in this recliner chair out here. Besides, you know the nurses call the resident for the minor things not you. Here--give me the call pager." I wiggled my fingers and opened my palm. "No worries. I'll call you if something's up, alright?"

She paused for a moment and then it registered. I was a fourth year. A super-duper pre-chief residency senior, no less. She smiled in acknowledgment and unclipped the pager from her hip.  Before I knew it, she and the intern had disappeared into the call rooms. I kicked off my clogs and hoped no one could smell the sweaty call-night feet that immediately wafted up toward my nose. I thought about putting them back on, but before I could I fell fast asleep in a snap.

I have no idea how long I was sleeping. I know it was long enough to feel good and short enough to not want it to end. Like always, at first I dreamed about placing arterial lines with 24 gauge needles and remembering the steps to neonatal resuscitation. Then I'd float off into some other magical place with no pagers and no post call clinics. . . . .

First came the sirens on the pager. Then came the voice of the operator blaring through the tiny device:

"CODE PINK! CODE PINK! EMERGENCY DEPARTMENT! UNKNOWN DATES!  CODE PINK! CODE PINK! EMERGENCY DEPARTMENT SIDE A! UNKNOWN DATES!"


Unknown dates?!? Crap!

"Unknown dates" was the worst. It was the most like Russian roulette of all the NICU situations in my opinion. There was no way to predict what you'd get. Either it would be an unfortunate teen who'd concealed a term pregnancy from her (also unfortunate) folks with basically no complications or a very early delivery that came so fast that there was no time to get a history.  The latter these two was a bullet straight to the brain. And unknown dates in the EMERGENCY department? That was the nail in the coffin.

Before I knew it, my stinky feet were stuffed into those clogs and I was off running like Flo-Jo toward the ED.  I could scarcely hear the NICU nurses -- one running steps a few steps behind me and another getting an infant warmer ready.

Once I pushed open the heavy door leading to the stairwell and made it down a couple of flights of steps, it dawned on me. I was the only doctor running. I knew Shanthi had been working so many wretched hours when I made a rookie mistake--taking the code pagers and assuming nothing could go wrong. Normally, she would have never agreed to such a thing. She was too responsible for that. But Shanthi was a second year NICU fellow and I was a fourth year Med/Peds resident. Technically, we were only one year apart in our training so she gladly bit when I offered. Plus she was so physically and mentally exhausted that her body melted at a chance to sleep perchance to dream.

Once I reached the corridor heading to the ED, the reality of what I might find began to press on me like some oppressive weight. I started reflexively praying for it to be nothing serious. I felt a tiny bit relieved when Olivia, one of the most bad-ass NICU nurses ever (wait, are there any other types of ICU nurses?) came jogging up beside me.

"Any clue about this mom?" she said.

"None at all," I replied still panting and heart feeling like it would jump out of my chest.

"Where's Shanthi?" Olivia queried with widened eyes.

I could feel the panic rising up in my throat as we neared the A side of the ED. "I have the code pagers. Shit, Olivia. I need someone to call her once we see what's up."

"NICU TEAM!" we both announced to the crowd of Emergency Department faculty and residents surrounding the patient. The crowd parted like the Red Sea to let us in. One of my buddies who was a senior ER trainee was gowned and gloved, prepared to catch the baby. She nodded in my direction and I returned the favor. An OB/Gyn resident was quickly getting ready to take her place at the foot of the bed.

I surveyed the setting. This mother was no teen. She looked to be in her mid-thirties and my chest started immediately hurting when I saw the tears squeezing out of the sides of her eyes. A tiny gold band on her left finger caught my attention. I didn't see her husband, but this did not look like what she had in mind at all.

"21 to 23 weeks according to dates. Prenatal care out of state. Here visiting a friend for the weekend. Water broke and started contracting and dilating. She's been given magnesium already but she's dilating and completely effaced." My ER friend was all business when she told me the little history she knew. Her voice was steady and staccato and she spoke like it was into a radio and not in earshot of the pregnant mother. It was a lot to take in.


"Shit." I realized I'd said this out loud but honestly? So much chaos was going on in there that my one expletive paled in comparison to the others flying around.  In came two more NICU nurses, Jasmine and Alice with the infant warmer and Marge the respiratory therapist extraordinaire preparing themselves for the delivery.  Marge hands me a pair of sterile gloves, a size 0 laryngoscope, and quickly began attaching things for an imminent intubation.  I had intubated many many babies by this point, but unknown dates always freaked me out.  I followed what I'd been taught and stood ready to secure an airway for this likely very premature baby. My heart was already pounding in my chest; I was sure anyone nearby could not only hear it but see it lifting my shirt off of my chest.

Because, see,  there was something else to all of this. Those gestational dates. 21 to 22 weeks. Somewhere in the gray zone for viability and a not gray zone at all for medical complications. Shit, shit, shit.  I looked around to see if somebody had called Shanthi but no such luck. Everything after that happened in slow motion.

The OB resident couldn't even get into place before this extremely premature baby came sliding out into the sterile gloves of the ER resident. More of those tears squeezed from the mother's eyes and the minute I saw that baby, I swear I wanted to do the same thing. She couldn't have been more than 22 weeks. A gelatinous little angel with skin as transparent as Saran wrap, fused eyelids, and the tiniest human chest I'd ever seen pulling hard over even tinier lungs for air. Her swollen genitals made me pause for moment before affirming that it was indeed a girl. An extremely premature girl. They positioned the infant right in front of me. . . all I needed to do was intubate.

My heart and hand froze for a split second as I looked at this sweet, sweet baby. . .pulled out of the oven waaaay before she was fully baked. Shit. I didn't want to be a part of this. I felt like I was going to suffocate from the fear and also from all of the people moving around me. Shit. She was no bigger than the center of my palm. This was crazy. Damn, this baby wasn't ready to be here. She wasn't. I glanced once more at her already grieving mama. Grieving the normal new mama life that she had envisioned and trembling with fear at what this new reality would be. Water broke. Out of town. No birthing plan or funky reggae music blaring in the delivery room. No husband coaching or grandmothers squealing in delight. Shit.  Once more I looked at her baby--all of this taking place over the course of a second--and something in my head questioned whether a resuscitation in a neonate this premature was even ethical.  I wasn't sure -- which to me was instinctively telling.

But there wasn't time for all that. Before I could even think further the scope was in her minuscule mouth and my eyes were fixed on her bleating pink vocal cords. Marge placed the endotracheal tube squarely in my hand and in the blink of an eye she was connected to a ventilator and off we went to the unit. Whether her mother liked it or not.

Shanthi met us the minute we stepped off of the elevators. "Jesus, Kim!" she gasped incredulously while staring at the baby and helping push the rolling warmer, "Heavens. What were the dates again?" She was saying the first thing that came to her mind when seeing this terrifyingly small newborn. I didn't blame her.

"22 weeks?" I answered flatly. Shanthi raised her eyebrows at me. "Okay. Maybe 21 and a half? I don't know. There was no history." I felt my lip quivering and quickly bit down on it.

21 and a half weeks. But what was I supposed to do? Say no right then and there? Shut the whole operation down and be the horrible devil that gave up hope? I knew this was complicated, I did. But something told me that doing everything wasn't necessarily the best option. Especially since the mom wasn't in on it all. This sucked. Royally. Shanthi knew that so she backed off.

The baby was here and alive and under our care so we leaped into action. In went the lines in her umbilical vein and artery. Every few seconds we checked the results of the blood gases sent to assess ventilatory status.  Baby P.  We worked on Baby P until the morning teams came in.

Shanthi and I spoke to Baby P's mom early that morning. Eyes bloodshot, body haggard and now with feet so sweaty and dog tired that I could smell them straight through my clogs without them even being off.  I did my best to explain what had gone on to Baby P's mom, and learned that morning that baby P was a little under 21 1/2 weeks gestation.  Shit. This was mom's first pregnancy and things had been going well. Turns out she had something called cervical insufficiency--where the cervix can't hold the baby inside once it reaches a certain size and weight. Most moms don't know they have this problem until it's too late.  Fortunately, the next time around (if there is one) mom can have her cervix secured surgically with a cerclage.

But now her extremely premature baby daughter was here. And just like me in that ER, what was she supposed to do? Give up on her first and potentially only baby? Hadn't we given her a promise that this could all work out okay since we went full guns blazing to keep her alive? Yes. She was here. Intubated and filled with tubes, fighting for her life.

Since I admitted Baby P, I was the primary resident caring for her. My attending that month was a hard core NICU guy and never even considered backing off with our heroic efforts once we learned that she was less than 22 weeks. Nope. That ship had sailed already.

Baby P lived nearly nine days. Her brief life was tortured, the majority of which was at my own hands.  She fought horrible infections, coded nearly every day, only to be brought back to life for a few more moments. Her brain bled two times and her little body seized repeatedly. Every single day that I cared for her, I'd steal away to sit in the call room or a stair well to cry. Trembling into my hands and apologizing repeatedly to Baby P and her parents quietly in the dark. Praying in simple language and feeling on the brink of nausea. Trying to forgive myself for intubating her that day and wishing I'd had the courage not to...or to at least present "nothing" as an option.

Two calls later, Baby P's heart stopped beating. Just like that. This time, following the parents' wishes, we didn't code her. Instead we all enveloped the parents in a giant, exhausted group hug. All of us weeping for reasons that you'd have to ask each individual to explain, but weeping all the same and not even trying to hold it back.  Me, the NICU nurses, Shanthi, and Marge huddled around the parents as they finally--for the first time in 8 days--got to hold their baby daughter. It was awful.

What had we done? What had I done?

I had to get out of there. I remember running out of the NICU. Past the nurses' station and past the waiting areas. Down the hall into the corridor. Just running and running. Out. I had to get out of there. I needed air. I needed out. I got outside and paced in the biting Cleveland autumn air. I folded my arms hard over my bare arms and tried to ignore the chill climbing into my scrub pants.  I felt like I had fought against God and against nature and lost. And whether you believe in God or nature or both, fighting them just feels inherently wrong. Unsettling and wrong.

Those 8 1/2 days haunted me for a long time. In fact, I cried while writing this because I could see those fused eyelids and air-hungry chest like it was yesterday.  All over again, I wished I had been with my fellow and not alone. I know that she would have put her foot down. I believe that. And smug me-- thinking our one year apart was no big deal-- learned a huge lesson that night. It WAS a big deal. A huge one. And yes, I realize that some 21+ weeker baby born under similar circumstances somewhere has a testimony and THEY made it and are alive and "just fine." I am sure that baby exists, but I also know that there are several others who don't have that testimony. Or they made it alive but no one would describe the outcome as "just fine." Not one bit. My guess is that those individuals might be easier to find than the former.

Medical training is wonderful and horrible. A lot of the decisions that get made are quick calls from one person, and they can change everything. Experience plays a big role in how ready you are to make those calls and that day, I needed back up.

At the end of that month, I asked Shanthi how she felt about Baby P and what had transpired. She began weeping and saying she was sorry for leaving me that night. She said she never should have let me take her pager. She was the NICU fellow in house. Not me.

"Would you have resuscitated her?" I had to know.

Shanthi looked down at her fingernails and sighed.  Finally she locked eyes with me and shook her head no. I swallowed hard and tried to fight the hot tears that began rolling down my cheeks as I nodded in agreement. I knew that answer before I even asked.

Things have changed since then. Now, a level III NICU is staffed with board-certified neonatal intensivists overnight. With enough experience to feel more confident in their judgment calls than I was as a resident. And when you're talking about little babies in very high stakes situations, that's probably how it should be. At least that's what I think.

The moral of this? I don't know. I guess I just needed to get the story out. Because medicine? Medicine is some serious shit.

***
Now playing on my mental iPod. . . . "Ready to Go" from Panic! at the Disco.

Me, the students, and a pug named Raisin.

Last Thursday, I opened my home to my October ward team which included two medical students along with the interns and resident.  Late that evening, I received a kind email from one of the students, and I was sitting there smiling. Harry looked over and asked what I was grinning about. When I told him it was in response to her email, he shook his head, chuckled and said this:

"You know you love you some med students!"

I responded to that with a hearty laugh because it was absolutely true.  Man. I adore the residents and can't get enough of the interns. Brand new faculty members always make me smile. But medical students? I don't know what it is about them. They just occupy a soft spot in my heart. Especially the earnest ones.  The ones who value their education and don't think they hung the moon and perfectly arranged the stars. I just love this phase of learning in medicine. . . .I guess it just seems so special to me. Corny, I know.

(Go ahead and wretch now. I'll wait.)

I think it's mostly because of the interactions I had with attending physicians during medical school--particularly on my medicine rotation. Internal Medicine is probably the most important clinical rotation you do as a student. Not because it's the best specialty out there, but more because it's really the foundation for everything and almost always can be applied to everything else you do--even if all that is is field the questions of nagging loved ones.  For me, the Internal Medicine rotation during third year was . . . how can I put it? Non-descript.  No one seemed to know or care what I was doing. Ever.

I spent a period of time thinking I wanted to be a surgeon during medical school. For many reasons I felt this way, but a lot of it had to do with the attention and care the surgical faculty gave me every single day as a learner. I never, ever felt invisible. They were expecting us each morning, prepared to deal with us, and always down for some teaching.  The Socratic method the surgeons used never bothered me--in fact, it was exhilarating. It pushed me to read and try.  By the end of it all? Fuggeddaboudit. I wanted to be a surgeon.

It took Dr. Robin W., a fantastic surgical faculty member, role model, and advisor, to bring it to my attention that people who go into surgery generally love being in the O.R.  "Oh that," I recall saying.  See, "that" was problem. The surgeons were rad and I wanted to be like them, but I hated being in the O.R. (I shudder just thinking about it.) I'd shift on my feet, daydream and eventually just pray for it to end. Or pray that someone would need a consult on the floor and that I'd be asked to scrub out. The scrub-out order was NIRVANA for me. (Funny, I know.) My other trick was that I'd sign up for the shortest cases and then have everything on the wards and consult teams tidied up when everyone finally finished in the operating rooms.

"Loving the wards and not the O.R. is called Medicine, Kimberly," she said matter-of-factly.  "You didn't like your Internal Medicine rotation, but that doesn't mean you don't like the field itself."

Ah hah.

And so after a few rotations at other hospitals during my fourth year of medical school, I realized that she was right.  I ended up applying to and matching in combined IM/Pediatrics, but the point is that I didn't choose surgery mostly for that reason.

Back to the students.   So that has a lot to do with why I'm so sweet on the medical students. I know first hand how important it is for faculty members to take the time for them.  I will always appreciate Dr. W. for taking the time to guide me to the right field instead of beating her bosom and declaring that she'd swayed be into surgery. How nice it would have been for her to create a little "mini-me" that year. But she didn't. She wanted me to be happy, so that meant first listening to me and then taking what she'd heard and telling me the truth. She didn't have to do that either. Many folks still don't.

I've found myself interested in our med students' futures--that is, the right future for the individual--ever since.  This means building relationships with them, and hearing what makes them tick. That happens in hallways, on wards, over coffee, and in classrooms.  But it happens. I make sure that it always does.

Thursday-day, I had a meeting with a second year student after clinic was over. That night was the team dinner. The next morning I was testing students. After that I wrote a letter of recommendation for a former student during a one hour break.  Lunch was a meeting with one of my Small Group Beta advisees. I had some free time after that, so came home and took a quick power nap. But after that? I woke up and met a third year student for coffee after seeing him looking perplexed when I asked about his future. And that meeting was abbreviated when I rounded up the afternoon by meeting with another of my SG Beta advisees.  It was a pretty student heavy thirty-six hours, I tell you.

I wouldn't have it any other way, though.  I think it makes such a huge difference, and I'm the first to say that I'm the one who gets the greatest benefit from all of it.  Any time I look back at match day last March, I know that every single moment is worth it.  Every last one.



Yesterday, one of my Small Group Beta advisees stopped by my house to show my kids her dog. I love knowing that medical students at Emory have these kinds of relationships with their advisors. . . . where a light is always on--literally--which sometimes leads impromptu visits. . . this time complete with a fiancee and a cute little pug named Raisin. 

***
Happy Monday.

The sunshine of my life.

Here's to my favorite Veteran. . . . .

The B.H.E.

Here's what I'm reflecting on at this very moment:  This dude right here.

I overheard Harry speaking on the phone to a friend a few years ago about some relationship issues. The friend was trying to decide what to do with their significant other.  I craned my neck and listened to my stoic better half sharing his view on it all:

"It shouldn't be this hard.  When you wake up in the morning and open up the curtains, either it's sunshine or it's not. That doesn't take you too long to figure out. It's either sunshine or it's not."  

I almost broke down and cried.  This isn't something he ever would have said directly to me, but hearing this as his simple truth on lasting relationships and knowing that I am his point of reference touched me deep in my soul.  And made me love him more.

I won't pretend like we have this seamless marriage where bluebirds chirp all around us at all times. We certainly have our days where we fuss at each other about dumb things. . . . and not-so-dumb things, too. Yes, there are days that we pounce on nerves and ask passive-aggressive rhetorical questions that get answered by pillow fluffs and turned backs late at night.  But mostly, it isn't that way because underneath it all, we love and respect each other.  And you know what else? We like each other, too.

We've learned to not keep score and to speak the other person's love language whenever possible. My love language is "acts of service" while his bucket is 100% filled by consistent "words of affirmation." In other words, he give the boys a bubble bath and I tell him how wonderful he is for doing it. It's win-win.

Oh? You don't know about the love languages? Take the test here. It's genius, I tell you. Genius, y'all. Thanks to this book, I don't even bother with buying Harry gifts. I simply make him some macaroni and cheese and tell him he's an awesome father if I'm trying to keep him happy. Now that I think about it, this post might get me a new mini-van! (My other love language was "receiving gifts." Harry's was "acts of service"--so don't think he's doing everything around here while I flap my gums about how much I appreciate it.)

Anyways.

The point of this post?  No point really. It's just a clear explanation for why there is pep in my step and a slide in my glide. There's something about knowing you're valued that makes everything else go a little bit better. . . .and sure, that feeling should come from within. . . but dammit, it doesn't hurt to have somebody on your team helping you.

When I married Harry, I was already a grown-ass, dual board-certified physician. In fact, I joined the Grady faculty as Dr. Draper--not Dr. Manning and was known to many as just that. Changing my name would certainly be a hassle, and moreover, getting the residents, students, staff and patients to start calling me by another name would be a downright pain in the behind. Realizing what a production this could potentially be, I asked Harry how he felt about me keeping my maiden name.

And his answer was this (with a cute little shrug of his shoulders):


"I guess I was just hoping we could be 'Team Manning.'"

*sigh*

How do you say no to that?

The Originals of "Team Manning"

That's exactly who we've been ever since.

***
Now playing on my mental iPod. . . .for the sunshine of my life.

The flame never dies.

Even though supervising a team of residents on the inpatient service can be grueling at times,  the end of the month is still surprisingly bittersweet. Especially when you've had a great team dynamic and everyone clicked.  There's something about being in the trenches together and taking good care of patients shoulder to shoulder that feels good--even when it's exhausting.

I've been fortunate to have quite a few months like that. After ten years on the faculty at Grady, some of them have started running together. . . but as long as I sit and carefully reflect, I can almost always knock the dust off of the best memories.  Some of those wonderful learners are faculty now and some have moved on to thriving practices in far away places. But all have left a little piece of themselves with me and I appreciate that.

At the end of each ward month, traditionally the team gets together for a team meal. I used to take my team to a restaurant (and still do sometimes--depending upon how junky my house is!) but now my preference is to have them over to my home. Tonight my October ward team came over for laughter, food and fellowship.  It was a perfect punctuation to an awesome month.

I'd split the month with my colleague and fellow Grady doctor, Richard P. He was gracious enough to step in when I begged asked him to share the schedule with me in October. Working on the inpatient service involves rounds on weekends and disruption to the family flow--especially with small kids. So Richard agreed to do the first half of the month and for me to do the same for him in March. I was so grateful when he said he'd alter his schedule on such short notice. My family was grateful, too.

So this dinner was extra special because in addition to having the interns, students and residents from my team, I also had another attending-- Richard P. --there.  We all sat at my dining room table laughing and sharing and honoring our patients through stories. This part was Richard's idea, and it was a lovely one indeed.  Everyone spoke so lovingly of their patients and the lessons. . . even the more difficult ones.  Rich started the discussion and set the tone.  And everyone followed his lead. It was beautiful. Just beautiful.

And so. I just finished cleaning up the last of the kitchen and blew out the candle on yet another team dinner. That candle represented another special team and another special month. . . brimming with its own memories, stories, lessons, and relationships. This time it was "Team J--for Jammin'." Led by Sandeep--a bright and eager second year resident--and rounded out by a collection of exquisitely different people and personalities. I stood there watching the plumes of smoke weaving into the air like floating threads of taffy. . . .feeling thankful for not just a job but a career that is centered around building relationships. It's a blessing to have an opportunity at the end of these months to break bread with people who value these relationships too.

So here's to my teams over the years. . . .Team J for Jammin' (with the mantra "committed to excellence!"), Team K for Knowledge aka Team Kiwi, all three versions of Team Awesome, Team Totally Awesome, Team OM-expletive-G the late-night rounders, Team Dynamic, Team "One Thing," The Roy Month Experience, Team Maravilloso, Team Alter Ego with Sameera A., The Spice Girls, The Dream Team,  Charlita's Angels. . . . .  and a decade's worth of other teams with unique nicknames that I've had the distinct pleasure of teaching, learning, and growing beside in this special world called Grady Hospital. The candle might get blown out at the end of the month, but trust me. . . . the flame never dies.

The Late Night Rounders--The Epic Month with Team OM-expletive-G

with members of Team Awesome aka The Perfect (Team) 10

From "The Spice Girls" ward month--here with "Posh" at her graduation.  (I was "Spice Boss.")

and at a residency graduation with members of Team "One Thing"

Good times, man.

***
Happy Thursday.

Nuttin' but love.

You walk on the moon float like a balloon
You see it's never too late and it's never too soon
Take it from me what it's aiight to be. . . .

. . . .in living color

And how would you feel knowin' prejudice was obsolete
And all mankind danced to the exact beat
And at night it was safe to walk down the street?

~ from the intro to "In Living Color" - lyrics by Heavy D

___________________________________

There's something about hearing of the mortality of people from my own generation that grabs at my heartstrings.  It evokes different emotions in me than those brought on by elders passing on.  When someone my age dies or gets ill, I feel like some kind of mirror has been turned on me saying, "You do realize you might be next, don't you?" Followed by, "And if not you, somebody your age that you care a whole bunch about--you do realize that don't you?"

So some of you reading this are fully aware of the identity of this man pictured above. For those who don't, this is a photo of a hip-hop artist known to most as "Heavy D."  Yesterday, Heavy D died at the age of 44 from a sudden death of unclear cause.

I'm sad about this because even though I didn't know Heav personally, I knew him.  He sold platinum albums and unlike many artists of this genre, managed to always be a good guy.  A fun-loving teddy bear of a person whose rap persona was larger than life--and a part of his moniker.  He never seemed to take himself too seriously, and with a chuckle, would proudly refer to himself as "The Overweight Lover."  I'm not sure too many big guys ever had this kind of "swagger" before Heavy D made it cool (plus if they did, none of them could move like Heav--no way, no how.)



He inspired a whole generation of hip hop kids. In fact, he was hip hop "royalty" as evidenced by this line in a popular rap song:

"It was all a dream

I used to read 'Word Up' magazine

Salt 'n' Pepa and Heavy D up in a limousine. . ."

~ Notorious B.I.G.

As someone who grew up in the inner city in the seventies and eighties, I was there when hip hop music was born.  I was on the corner turning double dutch and reciting every word to "Rapper's Delight" and practicing pop locking moves with my friends. I sat cross-legged in the living room watching Soul Train and hearing newscasters call this noisy chanting music "a passing phase."  Some people grew up with the invention of color television, younger folks grew up with the advent of the internet. Me? I grew up with hip hop.  And Heavy D was right there beat-boxing and break-dancing on the corners with us. . . .reminding us that our culture wasn't so bad after all. Affirming that there wasn't anything wrong with all of us hip hop kids of different shapes, sizes, and hues living our beat-filled lives in living color.

(Heav' had the best line in this compilation. . . . I still know every single word twenty years later!)

 Heavy D's conscious lyrics on the epidemic of black-on-black crime spoke to our generation:

"Here's the situation--idio(di)cy!

Nonsense, violence? Not a good policy.

Therefore we must ignore fighting and fussing

Heav' is at the door so there'll be no bum-rushing

They call us animals--Umm mm, I don't agree with them

I prove them wrong, but right is what you're provin' 'em.

Take heed before I lead to what I'm sayin'

or we'll all be on our knees praying."

~ Heavy D in "Self Destruction"

Anyways.  I guess I could look at all of this clinically couldn't I? I mean, I am an internist and all, aren't I? Surely, the doctor in me could point out the fact that it was only a matter of time before this obese man would face some kind of health consequences. Like I could say that his weight, though part of his M.O., was bad news and a total ticking time bomb so he got what was coming to him.  I could do that. But I won't and probably never will. Today, instead of making it clinical, I'm imagining his family and his friends and his fans and how broken they all must feel. I refuse to make this clinical because loving people and missing people isn't clinical, is it?

I was just talking to one of my medical students the other day about this very thing. She lost her father shortly before school started and we talked about how much she misses him. The things she wants to talk to him about and explain to him and seek his counsel on.  And we'd just been talking about death and dying and cancer and clinical things, but when I looked into her glassy, tired eyes, I recognized that none of that really mattered right then. Loving and missing someone isn't clinical. No it is not.

So yeah, I'm just thinking about songs I liked by Heav and what I was doing in my life when some of those songs were playing on my radio. I smiled when I remembered huddling around a television in my dorm room watching "In Living Color" and rocking out to his intro while J.Lo danced her heart out hoping to get discovered. That makes me happy to think of all of that.

Last month Heavy D had just made a mini-comeback by performing on The BET Hip Hop Awards show. No one had seen him on stage in years, and folks couldn't stop talking about how good it was to see him again! It was a medley of some of his best hits and best of all, he looked exuberant and happy and not like a "has been." Everyone was shouting, "Go Heav! Go Heav!" -- including me and Harry from our couch. Because for those of us who grew up with Heavy D, seeing him on that stage was awesome. That stage was our stage, too.

Heavy D was alive when EMS technicians reached him yesterday. It seemed to be some kind of cardiopulmonary arrest, but he was still breathing when they arrived.  He died shortly after reaching the hospital yesterday evening. Some part of me hopes that he wasn't terrified and also hopes he'd told the people that he loved the most exactly how he felt. Or at least showed them.

Less heavier version

For those who can't shake the clinical, I'll tell you this:  Heavy D had actually lost some substantial weight over the last several years.  He had dabbled in acting and appeared svelte in quite a few roles. This thinner version of "The Overweight Lover"  threw many for a loop.  In his last television appearance, he was back to the old Heav.  Seeing his weight up. . .then down. . .then up again told me something that I knew all along--that he was no different than any of us and was simply a work in progress. . .  just like me.

So here's to Heavy D, to works in progress, and to making your mark. Here's to taking the clinical out of love and adding a little more love to the clinical. And more than that, here's to living your very best life. . . . in living color.
 

Rest in peace, Heavy D. I got nuttin' but love for you, honey.
***


Heavy D's last performance at the BET Hip Hop Awards in 2011


And my favorite Heavy D video "Nuttin' But Love." (Hey SB~ check out Cynthia Bailey from the Atlanta Housewives pre-housewives.)

The Supreme.

"This ain't no place to be if you planned on bein' a star."

~ from Rose Royce's Car Wash

There is this car wash here in Atlanta that always tries to add on a bunch of other services every time you go there. Like, if all you want is a simple car wash, you know, with bubbles first and water second, they start blasting you with this laundry list of other choices such as tire shine or Armor All on the dash or chassis wash or you name it.  I don't get my car washed too often but when I do, you can pretty much guarantee that I'm not looking for it to cost the same as a car payment.

The last time I went, I had plans for a preemptive strike.

"I'll have the regular wash--and nothing else unless it's included in the price of the regular wash."

"So, just want to be sure," the car wash dude replied, "You don't want any tire shine or to have the alloy wheels scrubbed, correct?"

"Is that included in the regular wash?"

"It's included in the supreme wash, ma'am. That's only five extra dollars."

"No thanks."

"You can also get tire shine or alloy wheel cleaning a la carte if you wish."

"Is it free?"

"It's only three additional dollars."

"Per wheel?"  I muttered that under my breath but he heard me.

"No. Per service."

I sat up in my car and beamed with my brightest, fake-est smile. "I'll have the regular wash, then. And nothing else unless it's included in the price of the regular wash."

Car wash dude finally conceded.


On Monday I was seeing this woman in the residents' clinic who was in her mid-sixties. She had high blood pressure, diabetes and high cholesterol.  She also smoked a pack of cigarettes daily and was fairly overweight.  But her approach to this clinic visit was quite similar to my preemptive strike at Cactus Car Wash.

"I just need to get my medications refilled--and nothing else," she stated matter-of-factly.

I looked at her electronic chart and what the resident physician had documented. Her blood pressure was well-controlled as was her cholesterol. Her insulin regimen could use a teeny-tiny tweak here and there, but on the grand scheme of blood sugar control, hers wasn't too bad.  She really needed to strongly consider quitting smoking and getting on some sort of exercise and dietary program would also be indicated. Oh yeah, and seeing as she was sixty-something she also needed some screening and health maintenance things.  According to her chart, she wasn't up to date on her mammography, a colonoscopy, bone density screening, a pneumonia vaccine or a flu vaccine.

In other words, she needed the supreme wash, not the regular one.

"Okay," I answered carefully, "We can refill your medicines. Your doctor is going to make a small increase to your insulin, but otherwise you've been managing your blood pressure and cholesterol just great."

"Alright then," she said with her eyebrows raised. She totally had my number.

"I see from your chart that you keep your appointments. I also see your key chain with the photographs. Are those your grandbabies?" I continued.

She looked at me suspiciously. "Yes. I gots twelve grands but this is the little ones. I got some that's older."

I smiled and said, "It looks like you have a lot to live for. I'd like to talk about ways to keep you at your best beyond your medication refills. Would that be okay?"

"Honestly, doctor? No, not really. I don't take no flu shots, mammograms hurt like hell and the last time I got one they said I had to do it again and nothin' was even wrong. Tha's when I said to hell with that test."

"I see. You know, the idea is to catch things before they become an issue. I agree--I've had a mammogram and it's certainly no fun. But you obviously care a lot about your health because you keep all of the appointments. Would you consider--"

"I'll consider getting my pressure pills, my cholesterol and my insulin. Y'all need to be glad I even let y'all give me them insulin shots. My grandmama lived to make ninety and she ain't never had none of that stuff. Including that camera up her rectum." She shuddered and shook her head. "I really ain't getting that one."

My resident chimed in. "Did your grandmama smoke?"


Fail.  What did he say that for?


"Naw. My grandmama did not smoke."  She looked like she really wanted to add on "smart ass" but chose not to. Thank goodness he had the sense to stop that line of questioning.


"Can we strike a deal?" I quickly added. "Like, maybe we could look at them and decide what could be the most important to you."


"I told you what was important to me."


"Can I at least tell you the reasoning behind offering these things so that you can think about it?"


She nodded and at least gave us that, so I took what I could get.  My resident and I explained what could be prevented or caught early by getting a flu shot, a pneumo-vax, a bone density scan, a mammogram, and a colonoscopy.  We talked about which things disproportionately affect African-americans, which she happened to be, and described how missing an opportunity to make an early diagnosis could make a difference.  And she listened. She at least listened.

At the end of that visit, she got exactly what she came for--her medication refills and that's it.

I saw her in the hallway when she was leaving and she asked, "Miss Manning, have you had the colon test?"

"No, I haven't," I answered. "But my sister and my parents have. I hear it's not exactly fun, but I know from my patients that colon cancer is a lot worse."

She looked at me intently and nodded. "Hmmm. I might thank about that one," she finally said while folding her coat over her arm.

"Good," I replied with a genuine smile because I could respect that. I offered her a quick hand squeeze and wished her a great rest of the week.

That afternoon as I left Grady I stood looking at my car in the parking garage. I noticed the black smudge all over the fancy alloy wheels that I'd paid extra for back in 2004 when I got my car.  I imagined them gleaming like the way they looked back then and paused for a moment. Next I glanced at the dusty tires and narrowed my eyes. . . . 

Hmmm.  Maybe the tire shine and alloy wheel cleaner wouldn't be such a bad idea after all. I just might think about that one next time.

***
Happy Wednesday.

Now playing on my mental iPod. . . . Car Wash.