Punks need not apply.

My sister-friend Tanya has this saying that always makes me smile. She says, with a hand on her hip and a saucy curl of her lips, "Marriage (and parenting) ain't for no punks." And whenever she says that, I laugh out loud at the way she has perfectly distilled this simple truth down to just a few words.

Yep.

I will admit that mostly, the marriage part hasn't been the biggest conundrum for me. At least, not so far.  But geeze. I hear Tanya in my ear often when it comes to the parenting thing. I find myself shaking my head while folding up a basket of laundry or reading an email from a teacher or paying for whatever sport-of-the-week we're on saying, "Damn, this being a mama thing ain't for no punks."

And when I'm in the thick of it, the throws of it, that's when I really get what Tanya meant by that. Not punks as in punk-rockers or whatever other thing you think of when you hear that word. But punks as in weak, excuse-laden, lily-livered, milquetoast types that tremble like gelatin under pressure. Yeah, so I get what she was saying because parenting (and marriage) require a crap-ton of compromises, hard decisions, sacrifices, and suck-it-ups--none of which are for punks.

Unnnnh uhhh.

Parenting kind of stresses me out sometimes. Okay, not to the point of pulling out my hair and refusing to let my kids out of my sight. . . but still. It does. Sometimes it does in those "big picture" ways like hoping my kids are confident and filled with enough love for themselves and humankind to make good decisions and treat people well. Especially themselves. And I hope that me rushing them in the mornings or scolding them or being frustrated sometimes (okay, a lot of times) isn't damaging. So I lay in bed and pray things like, "Okay, God, can You just keep all of the good things I'm doing and chunk all the bad things? Thanks." And I'm serious, this is a prayer I say often, almost verbatim. I also say things like, "Protect my kids from monsters, especially the monster in me." And I say that because I mean it and because we are all a little broken in our own ways. So those monsters can come out sometimes to hurt more than just ourselves.

At least that's what I think.

Then there are the little things. Like whether or not my approach to my reluctant reader Isaiah is all wrong or even smaller than that like whether or not I have a solid plan to escape the house with my kids in the event of a real, true emergency. And, of course, I think these things only at 2 AM because this is the very best and most intrusive time to do so. So, in order to fall asleep, I just pray for some protection and for the God I believe in to help me to get it all right.

I'm rambling. I know. But I'm just thinking this morning. Thinking about how parenting ain't for no punks. Thinking about how once you get older there is so much to sift through and how hard this must have been for my parents. I am pondering it all and giving them mad props for what they did with us and feeling glad for their involvement in this round two but still realizing that Tanya is right, even with the help of grandparents, it still ain't for no punks. It ain't. 

Here's the other hard part. If you're lucky, you grew up with amazing parents like I did who provide you ready counsel and assistance with your own children. But ultimately, you have to decide what to do based upon your own judgement and gut and opinion. And, for me, this gets very hard because I deeply, deeply trust and value the opinions of my parents. But. . . . those same parents raised me to also seek and trust my own. Does this even make sense? I don't know if it does, so forgive me. I guess I'm just saying that this ain't for punks.

My guess is that when they raised us, it wasn't back then either.

The other day, Isaiah was sitting at the table reading a book. It was bumpy and he was whiny and I was frustrated. He's a bright boy and a proficient reader but prefers not to do it. And I reminded him that, like Auntie Deanna always said, "Readers are leaders, dude." And he looked at me and twisted his face into the saddest face I've seen in a very, very long time. He said, "I wish so, so bad that my auntie had just stayed a little bit longer." Then he just cried. A perfectly innocent eight year-old cry.

"I miss her, too," I replied.

"There is just stuff I want to talk to her about with school. Just a lot of stuff." And when I asked him what stuff, he said it was little stuff mostly but the kind of stuff he always talked to her about after school. And I got that because most of what I wish I could talk to her about is little, too.

But when it stacks all up, it feels big.

"Last night, I was missing her and cried until I fell asleep. I think of Auntie every single day. Every single day." And he was weeping when he said that. Hard. Getting it out of his little head and into the atmosphere.

"Me, too."

"And now I'm better in chess, Mom. And we could have played and I might have beat her now. I just wish she didn't die."

And what do you say to that? You tell me what do you say? So I just hugged him and listened as he told me a few of the things that he wished he could tell my sister. And, I swear to you, I wished equally as badly that he could, too.

He sat on my lap and I told him that we were lucky to know her so well so we could probably imagine together what she would have to say. And he seemed to like that, so we did. We did just that. And it was okay but still kind of tough. And the kind of thing that definitely wasn't for no punk.

Nope.

The time thing with kids? The building confidence thing and the discipline thing? The school thing with kids? Damn, it ain't for no punks. Man, it ain't.

But Harry and I slug it out. We do. And thank goodness we are at least equipped with some self worth and love for each other which puts us ahead of a lot of folks. This part I know. And I also know that getting the chance to do this is huge and I wouldn't trade it for anything. But it's just that I am recognizing the enormity of being trusted with raising up little human beings into whole people.

Yeah.

So I'm just thinking. Hoping and praying that the good things stick and the monster inside of me is kept under wraps. And please don't worry because I am loving it all yet trying to be intentional enough to get most of it right. Yeah. So I'm thinking about all of this today, but mostly I'm just agreeing with Tanya that this "being a grown-up" thing--which may or may not include marriage and parenting for some but does for me--ain't for no punks.

No, it ain't. 

***
Happy Sunday.

Eyes without a face.

image credit

I'm all out of hope

One more bad break could bring a fall

When I'm far from home

Don't call me on the phone

To tell me you're alone

It's easy to deceive

It's easy to tease

But hard to get release

(Les yeux sans visage)

Eyes without a face

(Les yeux sans visage)

Eyes without a face

(Les yeux sans visage)

Eyes without a face

Got no human grace

Your eyes without a face

I spend so much time

Believing all the lies

To keep the dream alive

Now it makes me sad

It makes me mad at truth

For loving what was you

~ Billy Idol

________________________________

BEEEEEP! BEEEEEEP! BEEEEEEEEEEEP!

That blood-curdling sound pierced through the air and jolted me from what felt like only ten seconds of sleep. I scrambled in the dark to figure out which of the three pagers on my nightstand it was this time. In my frantic state, I knocked two of those beepers onto the floor and, as Murphy's law always has it, one of them was the one I needed to answer.

BEEEEEP! BEEEEEEP! BEEEEEEEEEEEP!

This time it was coming from under the bed. My heart was pounding like it always did when a pager woke me out of much needed but never restful on-call sleep. After a swipe under the wire framed hospital bed, I came up with dust bunnies all over my arm and a pager in my hand. Just as it started to chime again, I silenced it and read the four numbers across the top.

"Ugggh!" I slapped my forehead and let out an exaggerated yawn. I recognized where that call was coming from. How could I not? It was coming from the ward and at this point in my residency I was very familiar with every one of those numbers. I picked up the phone and dialed back the extension. "Hey there. Peds Senior returning a page." My voice was grumbly and undeniably irritated.

"Kim?"

"This is me. What's going on?"

"Are you in the middle of something?"

This was what the second year resident covering the floor team that evening asked me. It was a few moments shy of 4 AM and I'd finally gotten the chance to slip into the call room for a few moments of rest after an exhausting night on call in the PICU (pediatric intensive care unit.)

"What's going on? Just say what it is."

I know that sounds rude but I was tired. Too tired for passive aggressive questions when all of it was leading to something that would surely require me to get out of that bed sooner than I'd intended.

"This baby who's been here for five days is getting treated for sepsis and meningitis. She lost her IV and needs four more days of IV antibiotics. She's a super tough stick, though. I tried twice, my intern, Priscilla our nurse, and even a NICU nurse tried."

"Ummm hmmm."

"Want to give it a shot?"

"Do I want to?"

"I mean, will you?"

I wiped my hand over my face in the most exasperated way ever even though I knew my co-resident couldn't see it. "How old is she?"

"Like not even two months. But a total chunker."

"I'll be at the treatment room in like three minutes. Can you please have every single thing set up?"

"Yes! Definitely!"  I could hear the relief in my colleague's voice. He was in his second year and was new at the supervisory role but me? I was almost over-the-hill as a resident by this point. In my fourth year of a combined Internal Medicine/Pediatrics residency, I'd been around long enough and taken enough calls to become savvier than my younger peers with certain procedures. It wasn't unusual to call the most senior Peds resident in the house as a back up on a failed procedure.

"Hey. . . .and no drama, either. I just want to come, do it, and leave."

Yes. That's what I actually said. And he knew exactly what I meant by that.

What did I mean by that? Well. Unfortunately, I meant that I wanted to make sure I didn't get wrapped up into the patient care or the people part. It was my request to be a technician and nothing else, the senior plumber who comes in after the sink is already pulled apart and fixes things with one tinkering then leaves the mess for the apprentice plumbers to clean up.

Yeah. Like that.

Now. I wish I could tell you that this is the part where I tell you that this never happened and that all of that was just to illustrate some kind of point I'm about to make. Nope. That happened. And not just once. It happened often.

What got me thinking about all of this was a conversation I had with one of my Small Group Gamma advisees the other day. He was deeply bothered by the way a resident depersonalized a patient during a procedure he'd been present for on his current clerkship. When he was telling me about it, it nearly brought tears to his eyes.

"How could that resident have been so callous? It was so, so disturbing, Dr. M."

That's what he said with his eyes widening in full anticipation of some really deep words of wisdom assuring him that THAT resident was a far cry from people like US and that WE could never, ever be that way. Never as in not ever.

But the problem is that I couldn't say that. I couldn't.

Residency training was a very demanding time. Although they still are, the hours back then were even longer and harder than anything I could have ever imagined. The learning curve was steep, the stakes were high, and growth took place at the speed of light. As horrible as pre-duty hours reform training was, it offered plenty of opportunities for exposure to experiences. And exposure meant repetition. And repetition is what led to mastery.

Yep.

But here's the problem with repetition: Eventually you get into a groove and your mind and hands operate without your heart. Like the two get in cahoots with one another and the emotion, the moment, the feeling of it all is sacrificed for efficiency and technical competency.

Even when you knew that these were human beings and not plumbing jobs.

It was four o' clock in the morning when I answered that page and I am almost 100% sure that I was back in the PICU reading a journal and talking to the nurses by 4:15 AM. The reason I know that is because, in my head, I wasn't a part of the care team. That IV was all business. Their business, to be exact.

So what happened? Well, I'll tell you. I walked in, washed my hands, and approached the treatment table where the nurses already had the little baby waiting. The intern knew to affix the tourniquet on the leg so that the veins would already be plump and engorged by the time I was finished putting on my gloves. That intern even knew where I wanted it placed because I'd already told the second year covering her to "save me a saphenous" -- as in the vein in the aforementioned location.

At that hour there weren't pleasantries, really. Just business. So after a few swipes with an alcohol pad, all that repetition took over. Hands like that of a robot on an assembly line. The flash of blood that came out of the angiocatheter was as predictable as I'd anticipated. And you know? I quickly flushed the catheter with a bit of saline, put one small piece of tape over it, and literally passed the baby's leg over to the intern to finish up the job.

"What about the blood draw?" the nurse holding the baby asked. The intern and second year looked around the room and rolled their eyes which told me that this was another technical thing they'd attempted and failed due to lack of repetition.

"Do you have a butterfly needle?" My voice was flat. Still all middle-of-the-night senior plumber business. The nurse handed it to me and without saying another word, I'd already reached for another limb on that poor two month old baby and plunged it deep into her wrist. Out came the blood, which I didn't even bother to stand there long enough to collect. Because my job was to get the faucet working. And once it worked, someone else could do the rest.

Yep.

So this? This is what I did more times than I can even count. Going through motions doing things to human beings as if they were faulty garbage disposals or commodes in the middle of the night. But see, they weren't. They weren't.

And let me just say that I cared. I did care for my patients just as much then as I do now. But back then I was burnt out at times and tired. I was able to compartmentalize people into the categories of "my patient" and "not my patient" and the former always got more of me than the latter. Which I now know was wrong. Very, very wrong.

This was modeled for me. I valued the senior residents and fellows who could stealthily walk in, nail a procedure and pop off their gloves less than two minutes later. These were the hospital legends to us, and I wanted nothing more than to be one of them. One of the ones who saves the day with few words and whose actions say "My work is done here" even though it never gets uttered aloud.

And there's nothing wrong with stepping in for parts of patient care. But the key is to know that there is a patient there. A human being. And once we get involved, we are involved.

I met a colleague during my visit to University of Pittsburgh named Bob A. who is a really cool senior faculty member with the kind of wisdom that you hold onto for later. He said to me during a simple chat, "Whenever someone calls the clinic or wherever and is needing help, I make sure I either help find what they are looking for or try to get them specifically to someone who can." And he went on to say that the person on the other end is a person with an issue and that, once he answers the phone, a tiny piece of that issue is now his, too. Which maybe you don't agree with at all, but I got his point. He just isn't a fan of punting things off when it wouldn't take much to be more helpful.

Kind of like it wouldn't take much to acknowledge the human being who needs the IV or the blood draw or the whatever-it-is-they-need.

So I was sad when I heard what my SG advisee said that day. Sad because I could relate to that resident who had become robotic like I had. No matter how hard I try, I can't remember what those middle-of-the-night patients looked like nor can I will myself to hear their cries. And I am certain that that baby was crying for her parents. Even at two months old she was, but her doctor--the plumber standing over her that night--didn't hear a single whimper. So I told that student about my experience as a resident and together we pondered if perhaps that house officer had reached a similar place.

"Eyes without a face," I said. My student raised his eyebrows for clarification. I went on. "We have to fight to make sure we never let the patients get to that point. Where they are eyes without faces. And it's up to the role models, you know? It's up to us to help keep that from happening."

"Hmmm," he responded quietly. I could tell he was trying to let it marinate and was curious about my choice of words.

"Eyes without a face. . . got no human grace. . your eyes without a face. . . . "

His eyebrows went even higher this time. He was confused now.

I groaned loud and laughed. "You don't know any Billy Idol?" His face fell blank. "Dude! Those are song lyrics, man. Apropos ones, too."

"Oh, okay," he laughed.

"Youngsters!" I shook my head and rolled my eyes skyward. "You probably don't even remember life pre-internet."

We both chuckled and after that prepared to leave. His face grew serious again as we walked out of the classroom.

"You made me wonder what my resident had seen from his supervisors. That's given me another perspective."

"In what we do, seeing other perspectives is everything."

"I'm learning that."

"Good," I replied, "It took me a while. I wish I'd realized it sooner. But when you know better you do better, right?"

"Definitely. I guess all you can do is what you know."

"Exactly."

And I could tell that he meant that and would be chewing on it for a while. I would, too.


One of the hardest realizations I've had to accept in being a physician is that, in a way, every patient is our patient. No matter what we think, it's true. And the minute we recognize that, it changes everything.    

At least it did for me.

You know what? I just thought of something--another perspective. Perhaps to those patients, I was the one with those terrifying eyes without a face. The one who'd gotten so tired that she'd forgotten the human grace she knew her patients deserved. Especially the ones she saw as belonging to someone else even though they were her patients all long.

Damn.

***
Happy Thursday.

Now playing on my mental iPod for the post-iPod era youngsters and the pre-MTV grown-folks. Mr. Billy Idol with the best scowl in 80's pop. Yes!

Ain't it good to know that you've got a friend?

"Ain't it good to know 

that you've got a friend?

People can be so cold

They'll hurt you 

and desert you

They'll take your soul if you let them. . . 

.  . . but don't you let them."

~ Carole King

____________________________________

I am so fortunate to have a cohort of very, very good sister-friends. The kind that get so close to you that sometimes you don't know where you end and they begin. Because so much of who you are is intertwined. Overlapping life experiences may have brought you together, but that's not what keeps you together. You know. . .shared things like pledging sorority or going to medical school or doing a residency or working at a place like Grady Hospital. Yes, those things start you off as peers or constituents but what happens next requires two percent choice and ninety-eight percent magic.

Yeah.

I've experienced that magic and am so, so glad that I have. Man, I am. Because when the magic is there, the choice part is easy-peasy. And it doesn't require much effort. Okay, I mean, sometimes it does, but mostly it doesn't. And that's something I'm very grateful for.

Very.

Over the past weekend, three of those magical sister-friends and I aligned our schedules to jump into a car and drive more than seven hours to see another of our sister-friends. A special weekend for five special sister-friends.

Five women who originally overlapped when pledging sorority together at the same college more than twenty years ago and with super busy, grown-woman lives plus or minus children (pleural), husbands (singular), demanding careers, and day-to-day operations that get so crazy at times that even answering a phone call seems like a tall order. But like I said before, when that magic is present, the choice part is easy.

Yeah, it is.

Boy, did we have fun. . . . 

We talked and talked and talked and talked. And laughed and laughed and laughed and laughed. And you know? We cried some, too. And all of it was safe and wonderful. It was. There was permission to speak freely without fear of judgement or unwanted repetition or psychoanalysis.

Which, if you ask me, is super, super awesome.

And just. . . .easy.

I've said it here before and I'll say it again. Women need women friends. We need each other to be stronger and better and bigger and brighter. We do.

Beware of the woman with no women-friends. For reals.

So me? I'm fortunate to have my very own collection of magical sister-friends of many beautiful hues from multiple phases of my life. I'm proud to have the ones I have and so happy to know our lives were in the right place at the right time for that magic to happen.

And I'm especially glad we all made the same choice at the same time to keep it that way.

Yeah.

***
Happy Monday.

Now playing on my mental iPod. . . . I'm equally in love with both versions of this song. It just depends upon my mood. . . but since JT and Donny Hathaway are two of my favorites, I can never go wrong with either.

First, this one from James Taylor (with Carole King):

Love how JT sings in such a quiet and tender way. I always find myself wondering how he found his singing voice. It seems like something that happened by accident. This makes me love him even more.



And next, this soulful rendition from Roberta Flack and Donny Hathaway. Good heavens, y'all. I love, love, love the smoky and haunting tone of Donny Hathaway's voice--ESPECIALLY when he comes in on that second stanza. He just KILLS it when he says, "Mmmmmmm, close your eyes and think of me. . . and soooooon I will there. . .to brighten up. . .eeeeeeee-ven your darkest nights." Chile, please. Beyonce's riffs ain't got NOTHIN' on Donny's. He KILLS it, do you hear me? I always yell the same thing the moment he comes in behind Roberta:

"YOU BETTA SING THAT SONG, MR. DONNY HATHAWAY!"

Ha ha ha.



Which version of this classic gets your vote? Who are some of your special can't-live-without sister-friends?

Thelmas and Louises.

Look out weekend. Here we come.

Push it.

"Because it's hard. And 'cause right now I can't."

~ Zachary "Zack" Manning

"Mom? I think when I get a little bit older, like when I'm maybe eight or seven-and-a-half, I want to run the 800. And then, when I get like ten or eleven, I'm want to run the 1500, too."

This was Zachary's declaration that he shared so matter-of-factly from the back seat on our way home from track practice the other day. The same kid whose coach has referred to him as "a natural" when it comes to sprinting and also one who was "made for the 100 and 200 meter races." Yep. The same kid.

"Really, son?" I replied. "That's interesting considering how fast you sprint and how much you like the shorter distances."

"I'm still gonna do the 100 and the 200. And the 400 sometimes or like on a relay," he responded. "The 100 and the 200 are my favorite ones, mama."

I glanced into the rear-view mirror and smiled as I noticed his post-track ritual of pulling his shoes off one at a time. "Are you having fun, Zachary? I mean, with track are you?"

"Yes, mama." He made sure to look directly into the mirror when he said that so I'd know he meant it.

"Good."  I was really happy to hear that because that particular day seemed to be an unusually tough practice. The team was running drills and pushing themselves in ways that I don't ever remember being pushed as a kid. And as I sat on the bleachers with the other parents, I was careful to keep my eye on my own little prize out there. Making certain to keep an inventory of his face and body language to make sure it wasn't too much.

But Zachary--or rather "Zack?"  He was in his element. 100%.

I kept watching him and began to marvel at how intensely disciplined he is with sports. It's almost like he has a tiny little "Mick" in his ear--like Rocky Balboa had in his face--urging him to keep going and to not quit. His little face gets so determined and focused and, when speaking to his coaches, he is careful and deferential.

We'd gotten a late start that evening so practice was running a little later than usual. The kids, ranging from kindergartners up to middle schoolers, were starting to get cranky. A few of the smaller ones had already melted down and were whining in ways that were completely age-appropriate. Finally, the coach dismissed the little ones and instructed the seventh and eight graders to do one more 400 around the track before leaving. "And push it!" he added as they took off.

A few moments later, from the corner of my eyes I saw Zack and another little girl on his team talking to each other while finishing the last chug-o-lugs from their water bottles. The other little kids were already over to the bleachers with their parents and preparing to leave. I started gathering my things--an iPad, a medical journal, and People magazine--and getting ready to take off, too. I bent down to tie my own shoe and then slung Zachary's backpack over my shoulder. With a yawn, I squinted my eyes to make out what was taking my child so long to join his departing peers.

And then, this.

Those able-bodied seventh and eight graders had made that final curve and were flying down the track on the last 100 meters of that last lap. It was a beautiful sight . . . really. The work they'd been putting in was underscored in their both their envious muscle tone and the way they floated across that track like gazelles.

"Bring that chin down!"

"Use your arms!"

"Stretch it out!"

"Push it to the end!"

Those were the things that the coaches were calling out to them and you could see those lithe bodies chastening in response. As each crossed the line, they quickly decelerated and leaned over onto their knees in tripod positions to grab as much oxygen as they could.


"You can't tell those two anything, can you?"

At first, I didn't know what this other mother meant by that. But seconds later, I did.

Two little bodies came bounding around the last stretch of the track, faces forward and arms pumping like tiny pistons. One with three pony tails whipping behind her like kite ribbons and the other? Zachary.

The coaches and all of the older kids started laughing and clapping.

"Bring that chin down, Zack!"

"Use your arms, little mama!"

"Stretch it out, y'all!"

"Push it in, y'all!"

And they did. Those two little ones had made the executive decision to do that last 400 meter run, too.

Their faces were beaming when they finished. The coaches and all of the other kids remaining offered them high fives and slaps on the back. And all of it was really endearing. It was.

So on the way home, like always, Zachary (a.k.a. Zack), chattered about the highs and lows of practice. What's funny is, though this was probably the most demanding of the practices I've taken him to, he seemed to be in higher spirits than ever. Almost euphoric.

"So yeah, mama. I'm gonna run the 800 next year. That's two times around the track, you know. And you can't run as fast as you can at the beginning or you'll get tired. Coach said you have to save it up and then push it at the end."

"I see."

"If you run, like super-duper fast at the beginning, you get too tired then you go slow at the end."

"Makes sense."

"And you really have to save it up if you run the 1500, mama. Like really, really, really save it up!"

"Hmmm."

I drove in silence for a few moments and thought about Zachary and this newfound sport. I wondered the things that parents wonder. .  . . like. . .is this too much? Is it fun for him? Am I robbing him of something? Is this worth the time commitment even? I glanced up into the mirror again where I caught Zachary drinking a mini-Gatorade and staring out of the window. His face was content and he looked happy.

Track was something we found because he wanted to do it. "I want to get my wind up for football and basketball," he said to us. That made us laugh, but when he looked hurt by our response, we knew he was serious. This was a calculated plan for him. A part of this innate discipline he seems to possess when it comes to conditioning his body as an athlete.

Even at six years old.

I bit the inside of my cheek and let that marinate for a few seconds. This? The "go hard or go home" mentality? That's something he got more from his father than from his mother. And I smiled at that thought because it's something I've gotten a lot of from him, too.

"Hey Z?"

"Yes, mama?"

"Why do you want to run the 800 or the 1500? You always say that you don't like the longer distances because you like to sprint. Mom is just wondering what made you change your mind and want to run those races, too? The 800 and the 1500?"

"Because it's hard. And 'cause right now I can't."

He took one more swig of the Gatorade, flashed me a big red mustache grin, and went back to looking out of the window.

"Because it's hard. And 'cause right now I can't."

Damn.

***
Happy Friday.

Thoughts to chew on: What limits are you pushing? What are you aspiring to do that's hard and that, right now, you can't? Personally? Professionally? Physically? Period? 

Now playing on my mental iPod. . . . as a reminder to push it!



P.S. Zachary told me that it's Zack with a 'k' because that's how you spell "track." Ummm, yeah.

Commencement Day, virtual and otherwise.

Here comes the sun

Here comes the sun

And I say, It's alright.

~ The Beatles

Whelp. The day has officially come and gone. After four years of working with, getting to know, and helping to grow our medical students, the time finally came for them to cross that stage, receive their diplomas, and sign their names into the alumni book with the suffix "M.D." Yep. And yes, you know how mushy I can get about these things, so I will do my best to keep this light. I mean, I'll try.

Man. The day was so spectacularly gorgeous. It was rather balmy and surprisingly cool which was the perfect companion for the cloudless sky we woke up to that morning. Instead of driving, I slung my academic regalia over my arm, tucked my high heels into my bag and walked to campus in flip flops and shades. Sure did. I snapped the picture above on that stroll because I wanted to remember how good I felt at that moment. I was totally hearing George Harrison's timid voice singing that gentle hook on my mental iPod. . . .

Here comes the sun (doo doo doo doo)
Here comes the sun
And I say, It's alright. 
(insert me singing the guitar and drum parts, too.)

Sigh. Love that song. I think it's my favorite Beatles' tune actually.

Anywho.

Ever since I got appointed as a Society Advisor at our medical school, I've looked at Commencement Day completely different. For me, when one of my advisees is graduating, it feels like Christmas morning when I wake up. There are flutters in my stomach and I feel so excited that sometimes I can hardly sleep. I'm not kidding.

Emory does this really cool thing where the academic advisors affix their small group students with their doctoral hoods. So, literally, the students in my small groups that I've known and taught since their very first day of medical school, stand face to face with me just seconds after having their names called as "doctor" for the very first time.

First day of medical school and first day I ever met them (7/2009)

Talk about a full circle moment.

Hooding Dan W.

Hugging Dan W.

And if you are wondering if it is highly emotional for me, the answer is yes. Now admittedly, it's isn't quite as bad as match day in terms of my tear to snot ratio. Most of my ugly crying is reserved for the day I learn that my "kids" have officially secured gainful employment. But this? This moment is emotional in a stealthier way. No one is ripping open an envelope and screaming at the top of their lungs. There's no surprises or shocking revelations. But what does happen is that, in those few seconds where they stand before you, those years that you watched them grow up fly before your eyes. And, for me, that means those eyes will soon become tearful.

With Doris K.

This year, Doris started it. She looked me in the eyes, hers already wet with tears, and said, "Thank you so much for everything you've done for me. Thank you so, so much." And I looked at this beautiful brown girl standing in front of me and felt my chest swell with so much pride that it couldn't be contained. She looked so strong and beautiful and confident. In those years, she'd become a wife and a mother and now, a doctor.

With Marla W.

"No, thank you for making me so proud," I whispered back as we hugged. And since she was the first of my small group advisees to cross the stage, I knew that my emotional state would only worsen with each hooding. We'd even planned as a group to fist bump before hugging to keep me from becoming a blubbering mess.

It didn't work.

With Jenna M.

Yeah. It's just such an awesome thing to get to do. To be there from the first day and to get the chance to be there again on the last day in such a significant way.

Well. Now this is Kevin S. and though he is not in my small group, he is every bit as dear to me. Though I didn't hood him, I shed my share of Kevin-related tears after commencement.  I've spoken of him before, so you know I think the world of him. We always saw each other and talked so often that when I was talking to him in the atrium that day and preparing to leave, it dawned on me that he was moving away to Boston. Instead of our regular, "See you next week!" -- it instead was punctuated by me stopping mid-sentence. I'm really going to miss Kevin.

On a funnier note, my friend and fellow Grady doctor, Wendy A., was also one of Kevin's mentors. We've always affectionately referred to him as "our boy". . . almost like he was our son. That always felt right since we both felt equal amounts of pride for all he's done and will do.

"Man! We totally need to have another baby together, Wendy!" I laughed. "Our first born came out pretty damn awesome." And that made Wendy, Kevin, and me laugh out loud.

But seriously. We are going to find us another baby to adopt and raise together in the next few months. Stay tuned for that. Hee hee.

What else? Oh!

Remember this guy that I mentioned last week on my thankful list? In case you forgot, this is Ira S., one of my colleagues in the School of Medicine. Actually, he's more like an awesome mentor-friend that, as you already know, I deeply, deeply heart to the umpteenth power.

He's also a kick ass teacher.

So guess what? My Ira lovefest was timely because it makes this part require less background information. Ira S. was awarded the Evangeline Papageorge Distinguished Teaching Award for 2013! Woo hooooo!

Y'all! He was SO surprised. I mean, he's such a humble dude that it never even occurred to him that this would be something he'd win -- which made it all the better when he did. They asked former recipients of the award to stand, and when they did, Ira was applauding super hard and nodding in the directions of those standing with this affirming Ira-like expression on his face. You could have mopped him right up off of the floor when they called his name.

I love that our students and the alumni association chose to recognize him. It's the highest teaching award bestowed upon a teacher at Emory School of Medicine and I cannot think of a more deserving soul than Ira. He's amazing and the embodiment of everything this honor describes.

Ira S.

Yay and yay.

Oh--and the other yay is for Ira's wife Janet S., who is every bit as awesome as he is. All I'll say about her is that she makes me love Ira even more. I am enchanted by smart and thoughtful people. Janet S. is like that.

Team S.

I heart this picture of them so much. The expression on Ira's face will always remind me of the conversation that Janet, him and I had just had before I snapped it. And that conversation was a very, very good one that I'll cherish always.

Yeah.

And you know what else was super sweet? Several of his former students came in support of him. They somehow got wind of the win and came as his "family" since his own kids were out of town. And those students are now busy resident physicians and chief residents who did whatever it took to be there.

Grady Chief Residents Victor and Francois, and intern, Jen S.

And since I know what Ira means to them, too, and what it likely took for them to make it to graduation, this snapshot I took of them standing at the back of the chapel sort of makes me want to cry every time I look at it.

Sigh.

Oh. Here's a few more lovely shots taken with my trusty iPhone.

This one is of Yewande A. She was the recipient of the student version of the Evangeline Papageorge Award. It's the highest honor any student can be given by her classmates at commencement. She's so, so awesome. I was so happy for her I cried when she won that award last week.

I guess me crying is becoming less and less of a shock, huh?

With Dan W.'s whole family who taught me how to say "Congratulations" in Mandarin to his Grandmother.

She'll be doing a combined residency in Emergency Medicine and Internal Medicine. Wow!

Oh, and this:

Yes! This!

This is Bryan O. -- who I've also talked about here before. I don't have a picture of it, but Bryan O. was selected by his class to deliver the student address at Commencement. Can I just say he BROUGHT IT? He truly put his heart and soul into that speech. There wasn't a dry eye in the room.

Here's our text exchange after:

Yes. That was his "Firestarter" speech. (The inside joke on that is that I recently gave a lecture this year to the fourth-year/graduating students for what's referred to as the "Firestarter" lecture. The requirement of it is really to inspire people and, well, ignite something in them. My friend the Profesora in Pittsburgh was the very first one to ever give one in 2011--a super tough act to follow!)

Congratulating the profesora after the inaugural "Firestarter" lecture--AWESOME! Hello?

Right before my "Firestarter" lecture 2 years later. . . 

Oh. Where was I? Bryan's speech. Yes. Dude. I wish you could have heard it. He killed it. He was such a responsible steward of the time he was given. He was. I've gotten to know him quite well over the last year. I felt so lucky that I did. Yes. That dude started some fires, do you hear me? The Profesora in Pittsburgh would have approved that message for sure.

I'll keep the light on for you, Dr. O!

And lastly, this:

I think I mentioned before that 5 of my 8 members of Small Group Beta were graduating this year. (The others took additional time for other academic endeavors such as research and Masters' degrees.) Anyways. This photo includes four of those five. The fifth person? He isn't pictured. And no, it wasn't because he was gone to the mens room. It's because he wasn't there for graduation.

At least, not physically he wasn't.

Mark G. had to leave right after finishing classes to go and be with his parents overseas. One of his parents is under treatment for a serious health issue that limited their travel to the US for the  commencement exercises of their only child.

Yep.

But man, oh man. Mark was so mature about it. He simply expressed that this moment was more for his parents than him and that he'd rather be with them than anywhere else. Even if it meant missing his medical school graduation. Man. And yeah, he was the first to admit that it would be a bummer to miss this but was even faster to admit that it would be even more of one to be there without his parents. No one had to twist is arm or any such thing. He was strong in his resolve and remarkably fine with the idea. I think his attitude made it easier for them. I'm sure they were more disappointed than he was, and isn't it just remarkable that they raised a son who knows what's really important?

Damn. I was proud of him when he told me that. It would be bittersweet but I was glad that he was sticking to what has always been a mantra for our small groups:

"Family is always first."

Yep. Which is really just something to remind us not to ignore those that matter or to make poor choices  because we don't prioritize correctly. Kind of like I did as a student when I missed Deanna's law school graduation because I "had to study."

Uuuhhh, yeah.

But still. After knowing him for four full years, even though he was being a grown up about this, I still wanted him to have his pomp and circumstance moment. I did. I also wanted his parents to have it, too. Mark's biggest concern was his parents and how much they'd looked forward to this. There had to be something we could do. There just had to be.

There was.

With the help of some Small Group Beta, one of our deans (Thanks, Dean Eley!) and a few others, we were able to create what I affectionately refer to as "Mark's Virtual Med School Graduation" -- aptly to the tune of "Here Comes the Sun." And can I say that I felt every bit as proud of his moment as all of the others?

Mark gave me permission to share it with you. Even better than these photos above, it gives you a good idea of what Commencement Day is like at Emory University School of Medcine-- and also why I always feel those flutters in my stomach . . . and those tears pooling in my eyes. . . year after year.

Thank you, Mr. George Harrison, for the perfect soundtrack to this perfect day. Consider enlarging the video to see it better (and ignore the giddy lady at the beginning because she didn't get much sleep the night before.)

Commencement 2013 from Kimberly Manning on Vimeo.

Best. Job. Ever.

***
Happy Commencement Week. Virtual and otherwise.

And remember: Family is always first. Virtual and otherwise.