Stand and Deliver.

 "Got my hands doin' 

things like they s'posed to
Showing my heart 

to the folks that I'm close to

I got my eyes 

though they don't see as far now
They see more 

'bout how things really are now. . ."

~ from The Color Purple (on Broadway)

 _______________________________________________

 Sigh.

I'm so grateful, man. I get to do what I love for a living. And. I get to do it in a place that is gracious and welcoming and accepting, too. I do.

I get to work with amazing people every day. I get to laugh out loud and sometimes cry, too. I get to examine patients and I especially get to examine myself. Through these relationships and moments, I get to uncover layers of who I am to get closer to the most authentic version of me. 

I get to build relationships inside, outside and even down the street from the hospital.

I get to be a little silly and to be a lot serious, too.

And as I do, I come here to deconstruct it all and put it back together again. To help myself to get the lessons and see the beauty in all of it. And to, just maybe, help you do the same. 

But especially, in my professional life I get to teach. I get to do what I love in a setting that feels like a ministry. . . filled with rabid learners who want to get it right, too. Who want to be better and who want to connect with patients on the most humanistic level possible. And that's totally awesome.

Totally.

Outside of work, a lot happened this year for me. Death hitting your immediate family is one of those things you just can't get your mind around until it happens. My family has been walking through a pain so mind-numbing that it's hard to even explain. Learning to get used to a life that doesn't include my sister Deanna in three dimensions has been hard. So trying to do the things that we need to do and have to do in our professional lives while our hearts fly on one wing has been challenging.

It hasn't been easy. It hasn't. But in some ways, I think it's made me even more aware and more intentional in both my personal and professional life. Kind of like I don't want to squander anything. Some days at work have felt really, really rich and really, really right. And others? Well, let's just say they weren't. Suffice it to say I'm thankful for bathroom doors on wards that lock. And for the tissue boxes issued by the hospital.

Yeah.

Considering this year and all that it entailed--more than ever--I'm just glad to be here. Still standing. And somehow able to deliver on what I'm supposed to be doing.

At least, on most days.

I know this is cryptic and kind of rambly. I apologize for that. I guess I'm just missing my sister deeply tonight. So, so deeply but in the purest and most beautiful way.

Does that make sense?

She was so proud of me. She was. People always told me that but I knew it already. Because she showed me through her actions. And she told me. It always brought her such joy to see me succeed even in the tiniest way professionally. I'm realizing right now how much I loved that about her. How much I loved sharing every little Grady triumph with her because her reaction always made me feel so . . .I don't know. . .special. 

Okay. So I'll go ahead and get it out. Last week, I received a teaching award. One that I would have immediately come home and told Deanna about first because she would have been the one keeping my kids so that I could attend the award program. And this one was a big one.

Deanna would have asked me to explain to her exactly what it was and then would have data-mined on her own in case I wasn't effusive enough. (This is what my sisters do.) And here's what she would have found when she did:

The Juha P. Kokko Award:

This award is presented to the faculty member who is voted by the residents as the best overall teaching attending in the residency program.  The Kokko Award is the highest teaching award given by the residency program.

Then she would have started asking me things like, "Is this for all of Grady or what? Has another underrepresented minority or black person ever won this award? Has another woman ever won this award?"

And I would have answered her quickly before she turned to Google. "No, it's for overall between the hospitals. Umm. . .no to the minority part. And as for the woman part, yes, once. Last year when my friend Joyce D. who was super-deserving won it." Then I'd have to listen to her tell me all about how much bigger this is than me and how she can't wait to tell any and every person who'd listen.

Because she was so, so genuinely proud of me.

And yeah. Our entire family is very good at the proud-of-each other thing. And, in all fairness, JoLai actually trumps Deanna in the spreading-the-word-of-whatever-it-is-someone-has-achieved contest when it comes to us or any of the kids. But I guess it just hit me on the way home from that program last Tuesday how much I wished she'd be there when I arrived. So that I could tell her first like always.

Now. Considering all of that, I am so deeply moved to have been recognized in this of all academic years. It goes without saying that first and foremost I'm just surrounded by so many amazingly talented clinician-educators. But I'm especially appreciative for this to have happened in the midst of me getting acclimated to my family's new normal.

And you know as soon as they called my name, that the little voice jumped right on me like gangbusters. Quick, fast, and in a hurry. Saying things like, "You sure charmed them, didn't you, Manning?" or "Um . . .do you really know enough to get the Kokko Award? Hmmm." And I swear to you, I had to chant in my head over and over again for the rest of that program:

Enough already. Already enough.

That kind of helped. But what really helped was having such wonderful friends that I could trust with these insecure thoughts. Because yes, they do creep up in us all.

And now I accept that what is uniquely my own style of teaching works for someone. I'm excited to do more and think more and try more things, too.  And, no, this isn't the first teaching award I've received or even told you all about, but for some reason this particular award was never one that I ever perceived myself to be "in the running" for. I'm glad to be in an environment that values many different teaching approaches and one that is filled with collaborative colleagues and gracious learners.

A friend of mine heard about this award on JoLai's Facebook feed. She reads this blog and asked why I hadn't immediately shared it here and I told her that I didn't know how or even if I should. Her reply was, "But we are a part of your community. And we want to be a part of this, too." I mumbled a few things back about not wanting to seem self-important or whatever and she reminded me that I'd worried about that at other times, too--and was wrong. Not to mention the fact that this is the same place I turned to on the very night I learned of Deanna's death. . . because I needed you all to know.

Funny. That night it never even crossed my mind not to immediately tell this community about that. Yet with personal triumphs it's always this weird dialogue that goes on in my head. Who to tell and how? Or at all?

Hmmmm.

I guess I'm just grateful on so many levels. Grateful for a career that I love. Grateful for my learners, my patients, and the gifts we give to one another. Grateful for meaningful friendships, an amazing professional mentor, and an institution that values what I can do. Grateful for a family that is yet holding on despite having a little piece of all of our hearts that keeps breaking over and over and over again. Grateful for this blog and the community of hearts that have been opened up to me. Grateful, man. Grateful for it all. 

Yeah. I'm still here. In fact, I'm even more than here. I'm present. I'm grateful for that, too.

I've got my sister

I can't feel her now
She may not be here, 

but she's still mine 

and I know

she still loves me

~ Miss Celie in The Color Purple

My sister was proud of me. That I knew for sure. And when people are proud of you and expect you to succeed, you rise. You stand. You deliver.

You do. And I want to do that for someone else. Push them to be better through expectation that they can. Just like she did for me. Just like my whole family continues to do for me.

Yep. Deanna was proud of me. And you know what? Right now? I think I kind of am, too.

***
Happy Saturday.

 Now playing on my mental iPod. . . 

Life in Pictures: June so far.

Life is full. Life is good.

***
Happy June so far.

Team Better.

When I took down your history on a note card, it all sounded so awful. A bumpy ICU course. Out of the intensive care unit but then a setback that took you straight back. Aggressive critical care with a molasses slow recovery. The discussion was punctuated with a deep sigh by my colleague.

"So I am thinking the goal is just lots of rehab and a long term acute care facility of some sort."

"Dang."

"Yeah, man. It's bad. Super unfortunate."

"Man."

And that was pretty much our exchange verbatim. A story laced with morose head shaking and helpless shrugs. The good fight had been fought. This would be your lot in life unless something really dramatic happened. A miracle even.

Let's be clear. You'd had a set of really amazing physicians doting over every aspect of your care. Smart ones with far more facts in their heads than I have. They'd consulted other smart people and all of their collective brainpower had not gotten you better. At least, not in the way that I define better.

Of course, they'd pulled you hard with all of their might from the grips of death. So technically that counts as better. But it was sad to see your face as you came to the realization that getting away from the death grip doesn't mean you've escaped the claws of disability.

So, yeah. "Long term acute care" was the plan for you which, for me, really meant not much more than making sure that nothing bad happened before a social worker could locate you a facility. And that, coupled with your age, didn't sit well with my soul.

After meeting you that first day, I couldn't stop thinking of you. I agonized over what our team--your new team--could offer you that hadn't already been tried. How could we add to this and was there any way for us to fight the inertia of your current assessment and plan?

The chart described your pre-hospitalization self. Mostly healthy with one or two medical problems that didn't explain the irreversibility of your current state. And you were young. Younger than me with a life filled with people and love and even a little dog. I'd bet you still had things waiting for you in the dry cleaners and a few dishes in your sink. This wasn't supposed to happen.

And so the things I offered you weren't rocket science. The most I can say that I did for you was not accept that you were destined for chronic disability.

"Listen. I've been reviewing you chart and I want you to know what has been going on." This is how I started that conversation that day. All you could do was nod your head because with so many devices connected to your body, your voice was rendered useless. I explained your hospital course including the parts where your body tried to slip away but didn't. And when I did your eyes squeezed shut and tiny tears rolled out of the sides of them and onto your dry cheeks.

"I just don't see a reason why you can't fight your way back. There isn't some. . .I don't know. . . like physiologic reason why. And by physiologic I mean like in the way your body is wired that would make you not get better."

"I want to get better!" you mouthed. And I understood.

Better meant you'd have a fight on your hands. It would mean determination and pushing hard through physical therapy sessions. It would mean keeping your spirits up by any means necessary and doing everything you could to not succumb to the suffocating blanket of depression. I told you just that and you furrowed your brow and let me read your lips once more, uttering those words like some kind of covenant vow. "I WILL."

And I looked at you and held your hand to let you know that I would fight, too. That I would come in every day and look at you like you could get better and talk to you like you will. That this would be modeled to my residents and students and we wouldn't give up on you or the possibility of you not going to a nursing home. Together, we would all be "Team Better."

And so. Something amazing happened. You started fighting harder than ever. And every single day, someone came up to me with an incredulous expression in awe of whatever stride you'd just taken. One after the other. Closer and closer to the person you once were. Or better yet, the one you would become once you left.

The other day, I looked at you pushing your walker with the therapist and said, "Look at you! You are amazing!"

And you smiled at me and said--this time audibly, "I feel GOOD! Like I'm gonna get all the way better!"

"We are Team Better, remember?"

You laughed when I said that. "We are. We are!"

We are.

I want to thank you for showing me another aspect of what I can do as a physician. Now I know that sometimes it has nothing to do with fancy work ups or high tech procedures. Sometimes the best thing I can do is believe that you can get better. Or healthier. Or off of drugs and alcohol. Or whatever it is that that threatens to nudge me into the learned helplessness that impedes everyday miracles. I can't fix everything. But I can make up my mind to at least try believe in the tiniest chance of your recovery. Because if I do, just maybe at some point, you will, too.

***
Happy Thursday.

Talking about your generation.

 

Today at Grady

What has been will be again,

what has been done will be done again, 

 there is nothing new under the sun.

Ecclesiastes 1:9

_____________________________________

Here is what they're saying about your generation:

They're saying that--since you don't work for thirty-six to forty-eight hours straight and since you get to actually take at least one day off in every seven and since during your emergency medicine rotation you don't get twenty-two twelve-hour shifts plus four separate continuity clinic days (that count as your "off days") and since you aren't falling asleep at stop signs and getting startled by security guards knocking hard on your frozen windows to wake you up in the parking lot post call in the dead of winter--they are saying that since you didn't experience all of those things you don't care the same. That, because your playing field is easier that your hearts don't ever get primed in that way that is necessary to become the kind of doctors we learned to be.

Nope.

They are saying that all you and your generation want to do is hurry up and leave. That you are of a "shift-work" mentality and that you aren't as invested as we once were. That you haven't taken enough lumps to understand that being dog-tired is just part of the job and that over time, if you put in enough hours, some kind of anti-exhaustion muscle builds up for you that allows you to function well on fumes of sleep. 

Yep.

Since the rules no longer allow anyone to tell you to "shut your piehole" and since you getting to have a say in just about everything is now the rule and not the exception, they're saying that you and your generation would prefer to spend your time complaining instead of hanging fluids or checking vital signs. That you and your smartphones and your social media live in such a different culture that none of you and your ways can ever align with us and ours. 

And that because of this you aren't as invested. That you are collectively selfish. And that you just don't and won't get it. 

That's what they are saying.

But today I saw this.

In the hazy afternoon sunshine, I saw a student doctor quietly wheeling his patient outside to get some fresh air. That's it. That's all. And I witnessed him smiling and talking and listening and connecting with his patient. Saying words like "Yes, ma'am" and "Beg pardon?" and making sure to go slow enough for it to feel like it was all about her and not about him. 

Yeah.

It made me think back to the day I clipped and filed my patient's finger nails and then painted them with dark red polish right at her bedside. A young woman with AIDS who was taking AZT but who was embarrassed by the way it discolored her nailbeds. And I remember going to Stop'n'Shop on Cedar Road to get a polish dark enough to cover up those tell-tale fingers. 

image credit

I was an intern in 1996 when that happened. No one was there watching over my shoulder when I gave my patient that heartfelt manicure. Not a single soul. But I was. And she was, too. The look on her face when I leaned over that tray table and then fanned her finger tips dry with my hospital-issued antibiotic card said it all. 

I saw that patient's face when that student rolled her by in that wheelchair today. Her eyes were dancing and her smile was easy. And the moment I laid eyes on her I knew that expression because I'd seen it before. Because it was the same look that my patient gave me on a late night in Cleveland, Ohio when a simple gesture involving a three dollar bottle of Revlon nail polish provided her more relief than anything else we'd done for her that whole hospitalization.

Yeah, man.

My eyes are open and I see things like this every single day. Right here, right now. 

Here is what I know for sure. . . . .

Patients are still people. Connections are still connections. Empathy is still empathy. And, even with a new set of rules, caring is still caring.  

And so.

What has been will be again.

What has been done will be done again.
 

  
And there is nothing new under the sun. 

Amen.

***

Now playing on my mental iPod. . .Listen to The Who and you'll see what I mean about there being nothing new under the sun. Don't worry--people were talking shit about their generation, too.