A Key Lime Pie was involved.

That and love.

***
Happy Friday from Manning, party of four.

Face to face.

She was even sweeter in person.

For the first time today, we met face to face. From that moment she sent that email at a point when she felt broken all the way to her victorious phone call some weeks later -- we had never actually met in person. It was all over phone calls and emails and text messages.

Imagine that.

So today we met in person. We talked about medicine. We talked about summer plans. And we talked about moments in time. (We also talked about which toppings are best on frozen yogurt.)

It was a really good meeting.

***

Top Ten: Crush on you.

How did you know if I never told?

You found out--I've got a crush on you

No more charades

 My heart's been displayed

You found out -- I've got a crush on you!

~ from The Jets "Crush on You"

____________________________

 Here's a really awesome family fact: My maternal granddad had this sweet nickname for my grandmother that not everyone knows about. I just happen to know because once on my wedding anniversary she told me that Granddaddy used to call her this:

"Reason."

Yes. You read that right. "Reason." As in . . . his "reason for living."

:::swoon:::

Okay. I can't say that the BHE calls me "Reason" -- but he does call me when he says he will and when he's supposed to. So that's reason enough for me to dedicate today's top ten to the BHE!

Man. Is it normal to have a crush on your husband? Because I kind of do. Case in point: We went out to this super awesome outdoor lawn concert last Saturday evening and seriously? I had butterflies in my stomach just from standing next to him and smelling his clean smell. Almost like I was at the eighth grade dance.

Sigh.

So I wrote a little top ten about it. Like to hear it? Here it go!

TOP TEN REASONS WHY I HAVE A CRUSH

ON MY HUSBAND*

* that just might surprise you.

#10  -- He's super swanky.

Did you know? The BHE is a snappy dresser. I'm talking effortless style. He doesn't have a bunch of clothes either. He just believes in owning a few good classic pieces. And especially quality shoes that can be resoled and withstand many years and trends.

Shhhh. Fact: He is a much better dresser than his wife. Much. He has an eye for things and never has to try hard. He has this way of always looking put together even if he's going to CVS to pick up my Allegra-D. Yep. That's just how he rolls.

Don't believe me? Just check out this swanky scarf he's wearing in this photo. How confident in your look do you have to be to pull that off? Seriously? Seriously.

Without fail it goes like this in our house:

Him: "Babe. Check this out. I got this today when I was in the mall getting my shoes shined."


Sidebar: Yes. He gets his shoes shined, which is a whole separate thing.


Me:  "Is that a . . .plaid linen scarf? What are you going to do with that?"


Him: "Wear it around my neck."


Me:  0_0


Him:  "You're tripping. This is hot to death."


Me:  "I'd say you're about to BE hot to death. In that scarf."


Him:  "I got it for the outdoor concert. You really don't like it, babe?"


Me:  "I more don't understand it." 


Him: "You'll see."

And once again, he was right. I saw and yes, was very glad to be his wife that night. Because that questionable scarf looked almost as HOT as he did. And from the scores of sisters that I saw rubbernecking in his direction, I know I wasn't the only one who felt that way.

P.S.  Did I mention that he dresses me QUITE often when we're going out? Uuuhhh, yeah.

#9 --  He's a man of few words.

But the ones he has are sweet ones.

By the way, the BHE is in my phone under "EMERGENCY CONTACT."  That's why you see that at the top. And for the record, he's also in there under "BHE", "Harry," and "I.C.E. -- in case of emergency."

Overkill, I know.

#8  -- He takes his sons to get a haircut at the barber--every single week.

Sure, every week sounds like a lot. But I will give you this quick cultural competency nugget: A whole lot of adult African-American men get their hair cut on a weekly basis. Not unusual at all. At all.

So here's the thing: The BHE feels strongly about boys learning to care about grooming themselves early. He thinks this should be ingrained in them as little boys so that they'll never be sloppy-looking as men. The BHE is meticulous about their pants being all the way up and their clothes and hair being neat -- at least at the beginning of the day. Perhaps some of this is his military background, but honestly? I think this preceded all that. Anywho. I'm not against it AT ALL because I get some free-to-be-you-and-me time every single week while they go to do this. Hellooooo mani-pedi!

Whoops, I mean. It's sooooo important that my sons are learning how to be responsible men from their dad. Yeah, that. Ah hem.

Letting their mama get a sweet power nap on a week day? Bonus.

#7  -- He is a master IRONER.

Yes. The dude believes in knocking back some wrinkles. Sure does. And before you ask--yes. He irons the boys' clothes every single day. Even on the weekends. One exception: Nylon soccer uniforms.

Oh, and one of our earliest new parent arguments? When we were going to a cookout with then three month old Isaiah. And he wanted to iron the one piece jumper before I STRAPPED HIM INTO THE INFANT CARRIER. Uuuuhh, okay.

Perhaps this is also military. But it could be Cleveland. I'm not sure.


#6  --  He always smells like soap. Always.

Soap at Lake Lanier

Soap at trick or treat

Soap on the ocean

Soap. Clean. Always. Wish these pictures were scratch 'n' sniffs.

Look. I don't know how he does it. But he always does. He always smells like soap. It's the most bizarre thing. Even his dirty laundry smells like Lever 2000 plus a hint of outdoors. But that musty armpit smell? Never.

Not. Even. Kidding.

Do you know how much pressure it is to do laundry for someone whose laundry you can't even smell to check for funkiness? Here is my solution:  If it smells like fabric softener, it's clean. If it smells like soap, it's not.

(The other solution I sometimes employ is just not doing the laundry. Heh.)

#5  --   He buys shoes for me without me being there. And they ALWAYS fit perfectly.

Not. Even. Kidding.

Here are the latest ones. I told him one day that I wanted a "super feminine peep toe in black patent leather. Because peep toes make me happy--especially if they have the perfect amount of peep." Then I explained to him what constitutes peep toe nirvana. He listened to me and. . . .

Voila! 

These perfect peep toes with perfect amount of peepage. Which reminds me. Too much peep makes your toes slide out. Which hurts like the dickens. But these? Perfect peep distribution.

5 points for Gryffindor for real.

(Please note the ironing board in the background.)

#4  --  He's cool, but not too cool for school.

Ever.

#3 -- He tells me I look "hot." Often.

But manages to find different adjectives for other women and for my friends. Even if they look hot, too.

#2  --  Even though he always smells like soap, he's always down for getting himself -- and the kids -- dirty.

he smells like soap here, too.

No smells from those pits. 

Can't you just smell the soap from here?

I wish I had pictures of them at the rodeo last week. They were filthy!

The boys smelled like wild animals. But the BHE smelled like . . .soap.

#1  --  He always roots for me instead of competing with me.

So I never have to shrink in his presence. Or water down who I am. Ever.

And that? That I appreciate that the most. I get to do me and he gets to do him. Full strength. And that's the best. Because being anything other than your authentic self is totally exhausting. Damn, it is.

So there you have it. Ten reasons I'm crushing on Brother Manning aka The BHE. He smells like soap, he's a great dad, he buys me shoes AND tells me I'm hot. It doesn't get any better than that!

*yawn*

That's all I got for tonight, y'all. Night night.

***
Happy Wednesday.

Now playing on my mental iPod. . .and regrettably on yours for the rest of the day. The Jets singing "Crush on You" in full 80's splendor!

People, perspectives and train wrecks.

The patient

This room is suffocating. Like every bit of air in here has already been used up and somehow I was left with the air scraps. But at least I'm in here. I just hope this doctor will understand.

Motrin doesn't work. Naproxen doesn't work. That last stupid doctor I saw in that ER had the nerve to part his lips to say "acetaminophen." Like I'm so dumb that I don't even realize that's the same thing as Tylenol. I looked that dude straight in his eye and let him know. This, Mr. Asinine Doctor, is not a "tylenol" kind of pain.

Or an acetaminophen one.

I need some shit that will work. Let me sleep and not feel sick. And you know? I just wish I could see just one doctor who listened to that and got that and got up off that high horse long enough to just give me some shit that works. No, not your bullshit tramadol or Ultram or "prescription strength ibuprofen" like you like saying. But something real.

Real, yes. And no, not half-assed real either. Like some tylenol -- "but with codeine in it" or naproxen and "a few pills of Flexeril." That isn't what wipes this pain out. Or stops me from feeling sick and miserable and like I'm going to hurt somebody.

So it all becomes this stupid assed dog and pony show where I have to say the right words and pray to the heavens for a doctor that isn't a damn know it all detective. You know. Those ones that get all high and mighty and decide that you are an addict simply on a mission to get high.

What the eff?

I'm in pain. Real true pain. In my neck. My back. My stomach. All over. And now, on top of that, if I don't get what I need, I feel sick. And like I'm gonna go crazy. For real.

My old doctor was cool. At least at first he was. He used to give me what I needed for this pain. He didn't make me feel bad or like some kind of addict or nothing and he gave me what would work. Like the hydromorphone or the oxycodone. That dude didn't hold back on this pain.

He was the one who gave me this medicine in the first place. I told him about my back and my neck and all that and he said, "Here, take this." And it was some oxycodones and that shit knocked that pain back. And when my body started getting used to them, he was okay with giving me a higher dose and then even giving me something stronger. Because that doctor? That doctor cared about me.

Yeah, he was busy and no, he wasn't too touchy feely or anything but, shit, that was cool with me. He wasn't gun-shy with that ink pen when it came to them pain medicines and I appreciated him for that. Matter of fact, that's what he was known for.

Then one day. . .just like the rest. . . .it turned into something else. That main doctor took that vacation or leave or whatever the hell it was and that partner of his was one of those bullshit doctor detectives. Asking me about past history of IV drugs and drinking liquor and all this shit that, to me, don't have nothing to do with this pain or this sick that I feel when I don't get my medicine.

So next thing I know he talking some shit about "weaning" me off the medicine. No more hydromorphone or oxycodone. Just some bullshit he came up with after speaking with some kind of pharmacist. All with a goal "to help me."

Help me? Help me!?

Man, please. The only way you can help me is to do something about this pain. Period. End of story.

So here I am all over again. Seven different emergency departments in six weeks because I really have no choice. No choice but to go there or to do something stupid in the streets to keep myself from feeling sick and in pain.

No choice but to do what I have to do.

image credit

The intern

Shit.

That man is my patient. That man. I already saw him when I walked through the waiting room writhing all around and rocking back and forth. Eyes all wild and body positioned all funny. I swear he moaned louder when he saw me walking by in this white coat. Can't even lie -- I hoped that he didn't belong to me. But Murphy's law. He did. That man.

Shit.

I still have to go back to the wards. And this? It's just too much. I overheard them triaging him and even that was hard. He just wouldn't stop pushing and explaining and moaning -- and that was just his vital signs being taken. Every so often he would let out this yelping sound that sounded like someone stepping on a sleeping dog's tail. I wasn't sure what to make of that, but he did look miserable.

Just not that miserable. Not yelping-out-loud-at-the-top-of-your-lungs miserable.

I looked over his chart and his chief complaint. And the refills he was requesting? Oxycodone? Dilaudid?

Dilaudid? Seriously?

So I introduced myself and listened to what he had to say. And just like in triage, he had a lot to say. A whole lot. And mostly, it wasn't so bad. He actually seemed to be a pretty nice guy for the most part. But it was weird the way he kept going from very, very miserable to very, very mad to very, very syrupy sweet and cooperative.

Something about it made me tired.

I wonder. Would it be the end of the world to just give him what he's asking for?

The attending

Ugggh. 

That poor intern. He looks so exhausted already. And seriously? I don't blame him. These kinds of interactions suck you bone dry. Dry of any traces of the already limited energy you came to clinic with. It sure does.

Especially when you're an intern.

A lot about this is just like what I've seen many times over. Youngish person comes in. Usually not fitting the more common demographic of our patient population. Why this is? I'm not so sure. What it usually suggests is that a wide net of providers has been cast. At least that's what it seems like.  So yeah, the story is usually predictable--some long and convoluted tale about their journey through chronic pain. A journey over rivers and through woods. Some reference usually to college education and a highly successful career that all folded in like origami after the nidus of this pain began. And somehow, some way that journey always seems to end with words like "oxycodone" or "percocet".

Or in this gentleman's case, "hydromorphone or dilaudid."

I know it's bad to think these things. I know. So I'd never say it out loud. But it is what I'm thinking. And I know it's bad.

Yes, it's bad because I know that every patient is different and that every patient has a story that is uniquely their own. But damn there are some truths or at least semi-truths that always seem to relate to this particular scenario. Always.

Truth #1:  I always feel the same way the moment I walk into the room. Tired. Immediately tired. And like I need to pay attention even closer because the words often feel slippery.

Truth #2:  I always end up scolding myself during the encounter. Telling myself to regroup and individualize this one person in front of me. To acknowledge how this one person is feeling and why they might feel this way. Admonishing myself to let go of the countertransference that I surely have -- and to be "the healer" that I promised I would be with that right hand up in front of Hippocrates and whoever else was listening.

Truth #3:  It usually doesn't end well. Even if, at first, it seems okay. Eventually it isn't. And that sucks because it's like a train wreck that you know is about to happen. At least most train wrecks catch you off guard. These kinds don't.

Wouldn't you act funny, too, if you knew the train you were on was about to crash? But I'm the role model so I can't act how I feel. Or even really say it without some sort of extreme filter.

Because really, I'm aggravated that some irresponsible person somewhere gave a patient this much narcotic. Or better yet, even more aggravated that they gave it to him repeatedly and then kicked him out of their practice because he kept coming back for more.

Duh!

Of course he came back for more. You keep putting heavy cream instead of skim milk on the back porch and what do you think is going to happen? Sigh. I know. I can't say that. Or make analogies like that because that's not cool. I know.

But I'm human, too. Remember?

So yeah. Now I'm standing beside my intern and looking at this man with a twisted snarl on his face sitting in front of me. And yes, I do believe that he is in pain-- I do. Pain of one kind or another. That said, I do not believe that his pain warrants the amount of exaggerated behavior I am seeing.

And that's what always leads to truth #1. That.

Damn. I'm exhausted, too.

Part of me wants to say, "Sir? Let's say all of this pain medicine is appropriate or at least some version of it is. Let's just say that. Can I just give you some advice? Don't do that. Don't do that thing where you behave as if a machete is stuck between your shoulder blades and as if your back is spurting out pulsatile arterial blood. Or make that blood-curdling sound like someone grabbed a pair of pliers and pulled four molars out of your jaw without a drop of anesthetic. Because that's how you're acting--hysterical--and this doesn't call for that. Besides. Real, true hysteria is something I've seen before. And it damn sure wasn't in a clinic talking about chronic pain."

That's what I want to say. But I never do.

Real hysteria? Oh, I've seen it. Once when this little pre-school aged boy got his foot caught under a riding lawn mower when I was a resident. He and his parents were really and truly hysterical. And you know? It was warranted. His foot was all mangled up and he was wide awake. Staring at it. The other time was when this kid was jumping on a bed in his cousin's bedroom. It was a high-rise and he leaped off that bed and crashed into a screened window. Problem was, that screen was loose so he fell. Six stories. So yeah, his family was hysterical, too.

And rightfully so.

Okay, and perhaps I did get a wee bit hysterical when I was having that nine pound two ounce baby, but that was before the epidural. Or the dilaudid.

But this? This is a dude walking around with pain of one kind of another, but not one that calls for all of this. Because real, true hysteria has to be short-lived because it is too exhausting to keep up with.

So yeah. These truths (or rather semi-truths) makes it harder to individualize care. Knowing that the train wreck is coming whether I like it or not. Because it is. It always is.

The interaction

"Hi, sir. I'm the senior doctor in the clinic today and your doctor and I have put our heads together about your health problems and the plan of care for today."

"Thank you, doctors. Thank you so mu--AAAAGGGGGHHHHHHH!!!!" The patient started taking deep, exaggerated breaths. Then he added through panting breaths, "Th-th-thank you."

"Mr. Fields? I have spoken to my attending about you. We went over all of the history together and I talked to her about your physical exam. Thank you for bringing in the records from the other hospitals. Do you have anything more recent than four years ago?"

"Arrrrrrrrgggggghhhhhh. . . .do you mind if I lay down on the examining table? I just can't take this pain. It's so---GRRRRRRRRRRR--I'm sorry. It's awful. Now what were you saying doctor?"

"I was saying that the records you gave us are from emergency visits but they appear to be pretty outdated. I want to be sure we aren't missing anything. I know you've had this pain in your neck and back since 2000. Did you have a primary doctor caring for you?"

"Listen, doctors. I had a doctor but eventually he told me I needed to come here to see you guys. He said he couldn't take care of my pain any more. Well, actually, not him. His partner raised some crazy concerns about me like I was some kind of addict. And like I told you, I have a Master's degree. I am not some kind of addict."

The attending interjected. "We want to be honest with you. Our goal is to have the same conversation with you in this room that we just had outside this room. We are concerned about these medicines and no, we aren't calling you an addict. But we do want you to know that we are concerned that there could be some dependency that you've developed on these medications."

"That's some fancy BULLSHIT WAY of just saying the same thing. I'M NOT AN ADDICT. YOU GOT THAT? " His eyes were wild and agitated. The intern backed up and the attending remained between the door and the patient.

"Sir, I never said that."

"The HELL you didn't. I don't know what you expect me to -- AAAAARRRRRGGGGHHHHH!!!!! I'm in PAIN! Don't you see?" The patient dropped his head into his lap and began crying. Hard, loud and exaggerated. Then it tapered off to a whimper. "You have to help me. . . .please."

The attending reached out and touched his hand. "We want to help you. We do. We want to do right by you. We think at some point you may have been given more than you needed. We want to be responsible in caring for you. Even if that means it's a little uncomfortable at first."

"I am happy to cooperate in whatever way you ask, doctor. I just want to not be in pain. I really do."

"First, I want you to know that we do believe that you have pain. I don't want you to feel like we don't believe you." The attending looked like she was willing herself to be patient with him. She was still holding his hand. The intern sat on a nearby chair watching.

"Thank you for helping me. I knew when I saw you that you wouldn't treat me like I was a junkie or something. I went to ivy league schools and have terminal degrees. I'm not the kind of person who would try to just get narcotics just for the sake of getting narcotics. I wish something other than Dilaudid worked for me. But that's what works."

The attending pressed her lips together instead of instantly responding. After an almost uncomfortable pause, she went on. "Words like 'junkie' and 'addict' are hurtful. I wouldn't call you or any of my patients those words."  The patient let out another hysterical yelp in the interim. She pressed her lips together even harder--this time with a deep inhalation.

"I'm sorry, doctor. I'm just so, so much in . . . aaaagghhh. . .pain." This time his voice was a tiny whisper. Almost cartoon-like in it's quality.

"We need to start a process to treating your pain differently. Something that doesn't involve all of these habit forming medications like hyromorphone and oxycodone.  I reviewed your records and also saw that you had a CT scan and an MRI here at our hospital. Fortunately, they were mostly normal with the exception of a little bit of degenerative changes from aging."

"My disks are herniated, though. You knew that right? One doctor wanted to operate. I couldn't afford it. My nerves are pinched from my disks being herniated." He winced again and began audibly gritting his teeth in pain.

"The images they took of you three months ago were much better. That happens sometimes. This doesn't mean you don't have pain, but it also doesn't sound like you need a surgery, so that's good. I noticed from your urine screen that the medicines aren't in your system. This way we don't have to worry as much about your body withdrawing from not having these medicines. It will take your mind some time to readjust, though."

The patient yanked his hand away and stood up. "So you're NOT giving me anything for pain? NOTHING for this pain?"

"We plan to have you go to our cognitive behavioral program for chronic pain. We also want you to see our mental health specialists, too."

"WHAT MEDICINES THOUGH? WHAT ARE YOU GOING TO GIVE ME?" Now he was up and pacing. His hands were shaky and everyone in that room looked nervous. The attending instinctively cracked the door open.

"The plan is to give you a combination of naproxen and also something for nerve-related pain called gabapentin."

"I've TRIED all that and that DOESN'T WORK!!! So you are just going to let me go home in PAIN? Do you even CARE?"

And that attending started trying to explain the best she could. All while coaching herself to stay calm and like something close to a role model. Something close.

The patient turned and looked at the intern. He saw that fear and confusion in his eyes. "Do YOU even care? I could tell that you did. Follow your OWN heart. Don't let what someone else says make you let someone go home in pain. That's the kind of doctor I KNOW you can be." And somehow in all of this he forgot to wince. Or yelp.

"Sir, I'm sorry you are in pain like this. I truly am. We want to help you," the intern offered. And he meant that. His eyes kept darting back over to his attending.

The patient crumbled to the floor and began crying again. On all fours in a way that startled even that attending who had been at this for several years. "Then help me with my pain. Even if you just give me a few to help me make it to another doctor. Please. . . .just. . .please."  And really and truly he curled up into a fetal position right there in the middle of that floor.

The attending gently closed the door again. "Sir? We will help you. But it will be a process. Today we cannot prescribe you any narcotics. It's important that you hear me say that because I want to be clear on that part. We don't think this is in your best interest. We will be ---"

And just like that the patient cut her off. He quickly got to his feet and snatched all of the papers off of the desk. "All of you doctors are FULL OF SHIT." He glared over at that doe-eyed intern. "And that includes YOU, TOO."

The attending opened the door all the way again and the patient marched past her. "I'm going to somewhere that actually HELPS people."

Both doctors stood by watching. Their eyes were on him and speaking words like "sorry that you feel that way" but this time only with eyes and expressions. Not mouths and sounds.

The patient made a ruckus as he walked away from them. Yelling expletives and saying really unflattering things about the doctors. At the end of the hall way he looked back at that attending and that intern and said this:

"I would have liked it better if you had the guts to just call me a JUNKIE or an ADDICT to my face. Cowards."

And with that he disappeared between the double doors. You could tell those words stung that attending like the unexpected snap of a rubber band.

Interestingly, a senior resident walked by and looked toward her with an amused expression. The kind that comes from being desensitized to such interactions. Unfazed by the sight of a train wreck.

The intern was not amused. He just stood there in that corridor looking like he'd witnessed a mugging. And the attending leaned against a wall wishing that truth #3 wasn't true.

Too bad it was.

So again, this was a train wreck. But one that they pretty much saw coming. And just like all train wrecks it didn't end well.

Sigh.

This? This is what complicates medicine and caring and healing so much. The patterns. We all fall into patterns because it's human nature to respond to what we can predict. You avoid Peachtree Road because you know the traffic is heavy. So you take Juniper instead. And you know that because you've seen that over and over again.

See, things in medicine have patterns -- but with these patterns there are people involved. And people are not as simple as patterns. They aren't statues just frozen in time and fixed into one position. They aren't traffic patterns or cell phone signals. They aren't. Not the patients or the providers.

No, they are not.

So the key, I guess, is to fight against becoming a statue. That's what made me write about this today. I need to flesh out these ideas and the perspectives of those involved. I want to fight myself to make certain that I never get so complacent with the sight of a train wreck that I look at it with amusement. Or freeze like I'm made of stone.

So I fight. We fight.

Fight to see the perspectives. Try not to take Juniper because of the train wrecks we see coming on Peachtree.

But most of all? To still be bothered enough to care when they do.


***
Happy Tuesday.

May 19.

Her graduation: May 19, 2012

My time

After all of the hard work

And all of the things I sacrificed

Now I finally know my worth

The whole of me it has no price

I thought I'd never make it this far

I underestimated myself

And though my life has truly been hard

Now I know the greatness of my wealth

I'm rich in love 

I'm rich in peace

I'm rich in hope yeah 

I'm rich indeed 

I'm ready

This is My Time

All that I'd hoped for is mine

It's mine, it's mine

I'm ready

This is My Time

All that I'd hoped for is mine

It's mine, it's mine

It's mine. . . . 

You'll know when that moment comes

And childish things are put aside

When you've learned to embrace your true self

And you really begin to live your life...

When you begin to live your life you'll see...

Just how ready you are...

I'm ready

This is My Time

All that I'd hoped for is mine

It's mine, it's mine

I'm ready

This is My Time

All that I'd hoped for is mine

It's mine, it's mine . . .

It's mine.

~ lyrics by Kindred The Family Soul

My graduation: May 19, 1996

***
Wow.

It all started with one moment in time. That led to a relationship that somehow became an awakening so profound that I couldn't even talk about it coherently at first. Then it set in that in the end, all things work for good. Finally I found some words to express what had left me so awestruck . . . . and for the world of people who were rooting for you, I am so happy that I did.

Thank you for allowing me to share your graduation photo. I knew that same world would want to see you standing tall and whole and smiling. Your face is filled with the pride that you have worked hard for and that you have always deserved.

My friend, Stacy H., who was one of the people cheering for you saw this photo and asked me if I was at your graduation. My answer to her was this: "No. Not physically. But I was there in spirit."

And I know that you know that I wasn't the only one there that way. 

It's so hard to believe that we still haven't met each other face to face. But now I know for certain that you don't have to be standing directly in front of someone to care. No, you do not.

Thank you for teaching me a lesson in bravery, faith and resilience. Thank you for being the true embodiment of "grace under fire." Because you did and you are. 

I am so proud of you. We are so proud of you.

This is your time. And we all know that you're ready.

I know for certain that you will pay it forward, too. That's how it works, you know. That's how we show our gratitude.

xo, 

Dr. M

***

Happy Sunday.

Playing this song for all of us today. Because really? This is all of our time. It always has been. . . Kindred the Family Soul sings "My Time" . . . . so beautiful and perfect for this moment.

To the world full of people who rooted for her. . .who offered well-wishes, prayers and positive energy. . . . thank you. Your energy, your thoughts, your belief made a difference. You do know that don't you? Let this entire experience be our reminder to seize our one moment in time. No matter how many times it comes to us.

We're going out tonight!

Now playing on my mental iPod. . . .a little old school R and B for your listening pleasure, too.


***
Happy Saturday.

All good.

(photo and exchange shared with patient's permission)

Heard that one of my F.P. all-stars was in the clinic the other day. Stopped by to see him before he left.

Me:  "Sir! Heeeeyyy!!! What you know good?"

Him:  "Hey sugar! I'm soooo happy to see you!"

Me:  "Sir! You know how happy I always am to see you, too."

Him: *smiling*

Me:  *smiling right back*

Him:  "You looking good. Like you happy in your life."

Me:  "I am, sir. I am."

Him:  *face gets serious* "You know? That's all you can ask for, right? Jest to be happy."

Me:  *silence*

Him:  *starting to cry*  "I'm very happy in my life, Miss Manning. Very happy."

Me:  *tearing up*  "Why does that make you cry, sir?"

Him:  "Because it ain't promised to you. 'Specially when you get to my age."

Me:  *silence*

Him:  "So it make me cry some to think about my life. It ain't been easy. But it's been good."

Me:  "It still is good."

Him:  *now full on crying*  "Yes, ma'am. It's all good." *points to the sky* "Cawse it's all God."

Me: *silence*

Him:  *wipes cheeks and sighs* "Love you, doc."

Me:   "You know what, sir? I love you, too. I really do."

Him:  *crying again*

Hug him tight before leaving the room. Gently step outside of the door.

*deep breath*


"You know what, sir? I love you, too. I really do."

I said that because it's true. I really do love him, too. And I really am happy. And no, it's not promised that you will be at any age.

 *Now crying, too.*


This? This is Grady. And it's all good.

***
Happy Friday.

Now playing on my mental iPod. . . . Mary Mary sings "Be Happy".


P.S. Every time I look at his sweet picture I want to cry. I really do. 

Make yourself at home.

At Pulak's home, May 2012

This is Pulak. Or rather Dr. Pulak.

Pulak was among our graduates who received medical diplomas from the School of Medicine earlier this week. And as you can see just from looking at her sweet face, she is something special.

She so very is.

I had the great fortune of being Pulak's attending on the wards at Grady last year. Pulak took exceptional care of our patients and really blossomed into a confident young clinician right before my eyes. That was the real start of our relationship and I am so glad that it was. Pulak is my kind of people.

Team OM-expletive-G, the late night rounders

Since then, Pulak has been excellent about staying in touch and thoughtful about maintaining our relationship. She sends me texts to let me know she's reading my blog and can always be counted upon to greet me with the same big, warm smile every single time I see her.

On match day, she was so elated when she got her first choice program in Family Medicine. That came as no surprise to any of us who know her and have worked with her. But being as humble as she is, she never took that for granted. And okay, I will go on the record and admit that both Dr. del Rio and myself tried to put on the full court press to veer her toward Internal Medicine. But since Pulak has such a strong sense of self, we failed. That same sense of self is what drew us to her in the first place, so that came as no surprise either.

So, yes, Family Medicine it shall be. Now Pulak will be bringing her brains and her heart and her trilingual-ness to the care of many lucky men, women, and children. At her first choice of programs.

Match Day, 2012

That was a proud day. And a special day, too. Her family was so proud -- and the love was evident. You can tell she grew up surrounded by it.

With Pulak's permission, I want to share a little piece of her family's love today. This was one of the most heartwarming demonstrations of love that I've seen in a very long time. Love as a verb. . . .yes. . . .in the form of a simple gesture--eating cake.

Last Saturday Pulak and her family invited me to join in her family's celebration of her graduation. I was honored to be included. Plus I love being around acutely proud -- wait . . .acute-on-chronically-- proud parents and families. And that is exactly what this was.

Yes, that's what it was. But it was also something more.

The minute I walked up to her home, the love was palpable. This party was for Pulak and only her, yet on her front porch there were over fifty pairs of shoes of all different sizes. I really wanted to snap a photo of it, but I feared one of the uncles standing outside would think I was a nutty stalker lady!

Anyways. Those shoes represented only a small part of the family, extended family and friends who had come there to rejoice at the accomplishments of this amazing young woman.

The door was unlocked, so after slipping out of my flip flops, I walked right in with bare feet. And that was cool because that is how they roll. Perhaps a part of being welcomed into her house with bare feet was cultural, but there was also this part that just said, "Make yourself at home." Which is exactly what every single person I encountered in that house insisted that I do.

Whether they lived there or not.

It was amazing. I felt immediately enveloped in the love that was infiltrating that home. The laughs were hearty, the languages spoken were mostly foreign to my ears yet somehow it was fully understandable. Because happiness comes across as happiness no matter what dialect the person is speaking. So yes, most people were speaking Gujarati or some mixture of Gujarati and English or some mixture of maybe Gujarati and Hindi even -- but still, I didn't feel like an outsider. Never once.

Not one bit.

Because me? My shoes were off and I was seated at a table laughing right along with the aunties and cousins and Pulak's mom, too. I hugged her grandmother and shook her dad's hand and proceeded to eat every single thing that her mom and those aunties enthusiastically put in front of me.

Without protest.

Next came my favorite part. The cake!

Pulak's parents ushered everyone into the dining room to cut the cake. And it was interesting because there weren't candles and this wasn't her birthday. Yet everyone instinctively gathered around and gave their full attention.

No. There weren't any cheesy toasts or slurring words. One person did sing a few bars of "For she's a jolly good fellow" but then decided that it was weird to refer to Pulak as a "jolly good fellow" so stopped. But not before giving us all a good chuckle.

So, no, there weren't glasses filled with bubbly being held in the air, but instead something much sweeter. The cake was cut and the first piece was placed on a plate. The entire family drew in close. I did, too.

And then this:

Pulak and her parents (Dad on left, Mom feeding cake)

Pulak's mother fed her the first bite of cake. Followed by her father. Then other family members who love her very much. And everyone looked and cheered and smiled and took pictures. And the love was so thick in that room that it was almost suffocating. But in a good way.

Pulak and her grandmother

I almost cried after watching her grandmother feed her this bite. The family helped her from her wheelchair and she participated in this dear, dear act of celebration. Just look at that sweet smile on her face! I was very close to tears and if it hadn't been for all the joy and laughter in that room I'm sure I would have been more than just close.

And you know? I am certain that I was the only African-American -- better yet non-South Asian -- in that room but I felt fully comfortable and a part of it all. Because like I said, love and happiness doesn't require a whole lot of explanations.

So on this day? I just took off my shoes, made myself at home and felt the love.

And so this week I am still reflecting on the aspects of my life and my career that I love the most. This moment with Pulak's family underscored once again what I know for sure: Building relationships is the best part. With patients. With students. With readers on this blog. With my family. With myself.

Yes, it is.

So, please. Take off your shoes. It's okay -- come in barefoot. Have a bit of cake. . . .

. . . and eat it, too.

***
Happy Thursday.

Congratulations Dr. PDP!

Acute-on-Chronic Parental Pride.

a·cute

   [uh-kyoot] : sharp in effect; intense; sudden

chron·ic 

  [kron-ik] : constant; habitual; continuing over a long time or recurring frequently

_________________________


My parents are chronically proud of us--that is, their children and grandchildren. They have no problems showing an entire iPhone folder's worth of photographs of their offspring to perfect strangers--or even YouTube videos in case that isn't enough. But, yes, the word for it is chronic because just like some longstanding medical condition this feeling for them is constant and habitual. And fortunately for us, it has continued over a long time.

Sometimes a person comes into the clinic with an intense and sudden pain. We call that kind of presentation acute.  Acute--like the definition describes, can be sharp in its effect. . .and kind of like the angle you learned about in 9th grade geometry, it has a swift incline. When we're talking about pain, that delineation between acute and chronic is important because it totally affects how we see it . . . .and how we treat it.


Pride for your kids is kind of like that, too. It can certainly be acute, depending upon the situation.


Sometimes in medicine, we see a patient who has a chronic or longstanding problem like . . .say. . .a bad case of sciatica. (Sorry to keep using pain as an example.) On some days--just out of the blue-- that normal undercurrent of pain gets much stronger. . . .more sharp in its effect. We have some medical jargon for that kind  of scenario, too. We call that kind of symptom "acute-on-chronic."  That's when you already have something but then your symptoms get a little added umph to them on certain days. 


Pride for your kids can be acute-on-chronic, too.


Stay with me. I'm going somewhere. . . . I promise. . . .

Yesterday I got to do something that forty-somethings rarely get to do. I got to make my parents acutely proud. So intense and sharp in its effect that my father broke down and cried. So sudden and strong that my mother came very close to exploding. But since my parents are already chronically proud of us, this was more of the acute-on-chronic type of pride. Which if you ask me, is something that deserves its own category.

Emory held its 2012 commencement exercises yesterday. This is a big day in these parts, and we have the traffic jams all around the Emory Village to show for it. Over 4,000 degrees were conferred altogether if you count all of the schools. Fortunately, only 130 or so of those were doled out at the School of Medicine ceremony.

me and Lisa B.

Okay. So first, I have to say this:

Our final "mean mug"

Antoinette graduated yesterday! And. . . guess what? I got to hood her! And look, this was a huge deal to me because you have to recall that I have known her since her very first day of medical school when she was assigned to my small group of medical students. So yes. Ant, my soul survivor from Small Group Alpha, received both her Doctor of Medicine and Masters of Public Health diplomas. . . . and I was the lucky person waiting on the other side of the stage. What an honor it was to be the first to hug her when they announced her name as DOCTOR Antoinette! 

And aren't you impressed that I didn't even cry?

Now. . . of course you can see from this photo how acutely proud this made me. Or rather it was acute-on-chronic pride. 


Yeah, that.


Which makes sense, right? I mean, she was getting a terminal degree and all. I know her parents felt an even greater sense of elation and perhaps some wistfulness, too. Because like I said . . . these hyper acute parental pride moments become fewer and more far between the older children get. So parents cherish them all the more. . . and they take lots and lots of photos to savor the moment for as long as they can.


At least they should.


Perhaps this is one of the toughest parts of seeing kids grow older. Less of those dizzying acute parental pride moments. 


Maybe? Maybe not.


Anyways. After we marched into the ceremony and assembled in the faculty seating on stage, I noticed an unusual sight right away:  My mother. I looked over at my colleague, Lisa B., who was sitting beside me and said, "Uuuhh, okay. Why is my mother at the Emory Med School commencement?"  


And Lisa, who is the world's worst liar, looked over at me and tried her best to look doe-eyed and innocent. "Your mom? Why would your mom be here? It's probably her Doppelgänger." 


Probably her Doppelgänger? Hello. It's my mom. Tounces. Shugsie. Cheesing with all thirty-two teeth showing and sitting on the fifth row.


"It's definitely my mom. I know my mom when I see her. I'm kind of freaking out. Why is my mom here?"


And Lisa just looked at me and then reached out to squeeze my hand. 


A few moments later, I saw a smooth brown head peeking out of the crowd--right next to the lady who looked curiously like my mother. Unless there was also a Doppelgänger there for the BHE, it was official that both my mother and my husband were sitting in the audience. At the Emory University School of Medicine graduation. Wait, huh? Last I checked, I'd already received my medical school diploma sixteen years before.


So I lean into Lisa B. again and say, "Uh. . .okay. The twin of my mom is sitting next to the extremely hot twin of my husband."  And her face just turned this very darling shade of red. Her eyes also started to water as only a true friend's eyes can in such a moment.


Deep breath.


The next part was surreal. A man -- who I am now lucid enough to acknowledge as the president of the Emory Medical Alumni Association -- goes to the podium and begins by first greeting and congratulating the graduates. After that he prepares to announce a major teaching award given by the Alumni Association each year called "The Evangeline Papageorge Distinguished Teaching Award."  I happen to know just how big a deal this award is because a few years ago, the very friend who was sitting beside me (Lisa B.) was bestowed that very honor. In preparation of my obnoxiously effusive email to our colleagues and friends, I did some data mining about the history of the award. 


And let me just say this: It's kind of a big deal.

"The award honors the legacy of Dr. Evangeline Papageorge, a graduate in the class of 1937 who was a beloved teacher and administrator. This coveted award is given annually at the School of Medicine diploma ceremony to a faculty member  'whose intellectual luminosity has generated the greatest excitement about learning among students and colleagues'."

Intellectual luminosity? Uh, yeah. That's kind of a big deal. Such a big deal, in fact, that when someone wins it, they often notify their family to be present. 


That or their Doppelgängers. 


And this is quite funny considering how many "intellectual luminosity" jokes I've cracked on Lisa B. since she won the award in 2009.  But that's okay because I have other awards to tease her about. 

Anyways. . . .ha ha. . .where was I?


Oh. . . so yeah, this gentleman begins reading excerpts of nomination letters about the winner. And these words are extra special because the only way to be nominated is by current medical students. So these were the words of learners. Verbatim. 


The way Lisa was squeezing my hand made it clear to me that just maybe these were more than just words. Just maybe, on that day, those words were about me. My heart was about to jump out of my chest with every quote. All I could think about was the fact that my mother and husband were under the sound of his voice. And especially my mom. And though at this point, I can't say that I was absolutely 100% sure that this was me they were speaking about, I knew for certain that if it was, that what it meant for my mother to hear them was exponentially better than anything I could be feeling.


Exponentially.


And then it was confirmed. He said my name. And people started applauding and my legs started feeling like Jell-o. My heart was pounding so hard that I put my hand on the shoulder of Dr. Felner, one of the senior cardiologists, as I walked to the podium -- just to make a note of where he was in case I had a full on cardiac arrest.


The rest was like white noise. 


As I returned to my seat, I sat there stuck in between two feelings--one of just wanting to run off the stage and hug my mother, my husband and all of my students -- and the other was just wanting to drop my head into my lap and do the full-on ugly cry. Then I thought to myself, "Now if my father had been here to hear that, he would have ugly-cried for every person in the room."  That thought made me smile more than cry.


That and Lisa B. squeezing my hand super-duper tight and hugging my neck repeatedly.


My colleagues were kind and offered thoughtful words and shoulder squeezes. It felt good to receive those affirmations, but especially knowing that one of my parents got to see it in person. And Lord knows that the BHE was proud, too, but we all know that it's different for a parent. It just is.


So this moment was wonderful and just when I thought I could not get any more so, I marched off of the stage and saw -- right next to my mother -- wait. . . huh? 


Gasp.


It was. . . .  my dad. 


Yes. My sweet Poopdeck standing on his feet and still patting his leaky eyes. He had flown in all the way from Los Angeles just to see his daughter get this award. And that? That was like a blast of helium that made me nearly float out of that chapel. 


Wow.


I could see it in their eyes. This was not their regular chronic proud. Yesterday, my father and my mother were acutely proud. On top of the longstanding, chronic pride they already had. Deeply, intensely, acutely proud. It's hard to even put into words.


Lucky me. Lucky us.


Even my brother was there. As busy as his schedule is, yes, he was there, too. Sitting right beside my husband like the brother he is to both of us. And that? You know that made my heart soar even more. Because I know that my dear husband and my sweet friend, Lisa B., had gone out of their way to get those important people there. And it did not go unnoticed. And it never will. Not one single bit.


When I walked outside I made a decision to pay very close attention to this moment. To intentionally take mental pictures in the highest of definition and to allow myself to savor the fine details. And yes, I know that I don't need to win some big award to make my family happy, but still. . . .this was a pivotal moment. Any chance you get to make a parent this acutely proud is pivotal indeed.

Happy Mommy

This picture is so her--so, so her.

The B.H.E.

always by my side

Does the brother hang a suit or what?

Dr. Ant!

Tounces has hugs and flowers for more than just me! Ant is a part of our family so it makes sense.

More Tounces, the smiling mom!

Ant with Jen S.-- she's staying with us for medicine! Yay!

Chatting with big brother, Dr. Will

Omega Men -- Dean Lee (multicultural affairs), The BHE, Poopdeck

We are family.

Marla (SG Beta) and Nate (advisee extraordinaire!)

I felt like I was the one who graduated!

Funny. I initially thought I wouldn't even post about this. I worried that it would be self-important to be telling it on the mountain that you won a big teaching award. But I knew that I wanted to hold onto that day so I went ahead and fought back that "little voice" knowing that I had to write about it. 


In fact, I read my writing mantra first. . . and then did just that. I wrote about it.

With Dr. Lee -- he's the best!

With my Department Chair, Dr. Alexander

with one of my favorite Grady doctors and leadership mentors,  Dr. del Rio aka "CdR"

With Neil W. -- mentorific mentor extraordinaire and celeb on this blog!

With Dean Eley -- my kind of people

It's interesting. Acute things are often short-lived but can make our patients pretty unhappy. Chronic issues can ruin someone's quality of life longterm. And acute-on-chronic eruptions of whatever it is a patient is dealing with can be eerily similar to throwing gasoline on top of an already crackling bonfire--


BOOM!


Unless you are talking about acute-on-chronic parental pride. Then it's the biggest and best kind of explosion you could possibly imagine. . . . .

me and my daddy

BOOM!

Sigh . .  . . yeah. . .like that.


***
Happy Tuesday.

My favorite shot of the day: Dr. J. Felner, prior recipient of the Papageorge Award -- 
"resting his eyes, not sleeping"

To the current and former Emory University medical students who took part in this nomination and who take part in my life every single day~


Words cannot express how grateful and humbled I am. I promise to honor your kind support and work even harder. Remember. . .the relationship between teacher and student has always been symbiotic. . .we need each other to survive. Thank you for teaching me, too. 


Pay it forward--and always keep it human. . . .


Dr. M


TOTALLY playing on my mental iPod right now . . . "Closer" by Goapele -- please listen. . .it's beautiful and so is she.



. . .and if it couldn't get better--Poopdeck left this and went to see his granddaughter (my brother's daughter) receive this--straight A's on the Honor Roll. . . .on the very same day. Talk about hyperacute-on-chronic Grandpa pride! Go Tyler!

(p.s. Sorry for all these weird giant spaces. They weren't for effect! Blogger was punishing me for some reason!)