The calm before the storm.

I could see it revving up. Her voice was growing louder and there wasn't any eye contact. Arms twitching in a tightly folded position, seated with crossed legs and a foot that kept rhythmically kicking. Whatever it was that was going on wasn't good.

Nope.

I wasn't involved actually. At that moment, I just happened to be down in the Emergency Department looking for a patient who'd already been wheeled upstairs. I'd popped over to one of the computers to check a few labs before hustling upstairs to find my sixty-something year-old man with heart failure.

She was propped on the edge of a gurney just a few feet away from where I was standing. A young doctor was speaking to her and a nurse was nearby doing industrious things that appeared to be in preparation for the patient to be discharged. And me, I could just see it. This patient did not look happy. But it was more than that. Her fuse appeared short.

Very short.

And so. Like someone rubber necking at a car wreck, I stood frozen and watching. Some perverse part of me wanting to be able to say, "See? I told you so" and needing proof of the outcome before I could.

Terrible, I know.

I could overhear bits and pieces of it. Mostly the issue seemed to be that she wanted a "head-to-toe CAT scan" which her doctor didn't seem to think was indicated. Her agenda wasn't being met and she wasn't too thrilled about that.

"What if I got cancer?" she said.

"Ma'am," he responded, "from what I've seen so far, we shouldn't expose you to all the radiation."

"I am fine with the radiation. I want you to check me all the way out for cancer. From head to toes with a CAT scan. It's my body. I know what I need."

And that young resident doctor just sighed and tried once again to take a different angle. None of which was working.

Now. You'd think that this wasn't really a big deal, right? But here is the part I could discern--partly from working at Grady for a long time but also just from something I felt in my gut: Her impulse control was on 'E.' And that meant 'E' as in empty.

"We're going to go ahead and discharge you now. I'm going to schedule you a follow up appointment in the Primary Care Center, okay?" That's what he said to her. Easy enough.

But that twitching foot started going faster. Her chest was heaving in and out and her eyes were flitting all about. She was sitting on the edge of that hallway bed and, from what I could see, was all alone. No loved one appeared to be pacing nearby.  It was just her. A young woman who appeared, really, to have not a single medical problem. But clearly something was wrong.

Very.

And so. It all began to swirl in slow motion. The nurse tried to hand her the after visit summary and her arms stayed tightly pressed to her torso. Her lip curled and her eyes rolled. Her nurse tried a little bit more, hand making karate chops to her flattened palm to reason with her one last time. All of it at a snail's pace. At least, from my perspective. The nurse then walked away, clearly exasperated but fighting to hold on to any threads of empathy. And that young woman swept her hand across the bed, flinging that discharge paper work to the floor. My breath hitched as everything went silent. In the pregnant pause, I watched them float down to the slick linoleum like feathers.

And then, someone hit fast forward.

First came the expletives. Loud, unruly and landing all over the emergency departments in awkward, awful splats. B-words and F-bombs screamed with reckless abandon, not to the individual caregivers per se, but to the system, the moment, the everything. And I just stood there like some terrible voyeur watching it all unfold. Wondering, wondering, wondering what had broken this young woman down so much that she'd unravel like this and lose every shred of impulse control?

What?

Was it a shitty existence at home? Screaming kids and no help or money? A horrible childhood that left her with so much noise between her ears that she couldn't quiet it no matter how hard she tried? Someone not nice awaiting her, with nasty words and swinging fists? Mental illness that was under treated? Or not even diagnosed?

Or.

Just a young woman who had none of those issues at all. Who just happened to be a bit nervous about her health and who was hoping for fool-proof means of making sure it was all clean?

Maybe.

And so. I tried making eye contact with her. Hoping to untrouble her waters from afar which is really a crazy and rather self important thing to believe I could do. But I did anyway. And, of course, it didn't work.

Eventually security came. Bear hugged her and lifted her feet above the ground. One of her shoes flew off and she was reduced to one bare kicking right foot and one sneaker-covered left one. They were nice-ish too her, despite her vitriol, but still they had to do their job. Which was to protect the other patients and the staff in the ER.

Sigh.

Now. I wish I could tell you that his ended with me walking over and hugging her. Me giving her a card to come to the clinic and her promising through tear-streaked cheeks to do just that. But it didn't. It ended ugly. Like, as angry as she was, there wasn't a way to do this in a dignified way. There just wasn't. So this was it. A lumpy ending that left everyone trapped in that awkward moment where you glance all around like you didn't see what just happened.

And that was that.

As I walked out of the ED, I started thinking. Thinking about that aura before the meltdown. Those folded arms, that tapping foot, that complex scowl. I replayed it and wondered what, if anything, could have been done to preemptively strike. To throw baking powder on the grease fire before it blows up the kitchen.

And no. I'm not criticizing my emergency medicine colleagues at all. Quite the contrary, actually. I guess I just wondered if, with that kind of knowledge, that kind of premonition if you will, what I would have done. And would it have even made a difference.

I guess the thing is. .  . . loss of impulse control is never normal if you ask me. Sometimes it's due to some mood altering substance, sure. It wears off and provides a sound explanation. But other times it is just life. Big fists punching or little tiny fists pummeling all at once. . .manifesting as nothing to lose.

Sigh.

I just want to be a better doctor and human being, man. I think we get these little prickles under our skin for a reason. Sometimes it's all because you need to haul ass and get out of the situation. But what if, in this line of work especially, it's a signal to rush in? To try your best to knock the door down before it gets blown off and hits you in the face?

Honestly, I don't know the answer to that. I don't. But that's what I'm thinking about tonight. And what I will likely be thinking about for a long time.

Yeah.

***
Happy Thanksgiving-eve.

Reposting these two posts because they are salient tonight.

Had to turn the news off. It got too depressing. Instead I just sat and looked at pictures in silence. Wishing the whole world could see what I see when I look at them: Cherished boys and men whose lives matter.

After a football game and a tough loss.

With the love of my life.

With their Auntie on Christmas

With their godbrother

Snow day with my favorite sons

Chilling. But chilly.

With my favorite football coach.

Leaving church with my favorite sons

Hanging out with Uncle Keith (Zach's godfather)

Does he realize the world he's growing up in?

With my favorite older son.

With my favorite brothers who aren't suspects.

These two reposts:

This first one was originally posted on August 25, 2014. But this right here explains what's so hard about being the parents of black manchildren and the extra stuff that we are forced to be concerned with that many of our friends will never, ever have to consider. This also gives insight into the added stress and fear I must register along with all of the regular fears that every wife has for her husband. Because my husband happens to be a black man.

Sigh.

If this makes you kind of uncomfortable? Just know that you aren't alone. And if you never have to think about this stuff for your spouse or your kids? Thank God . . . or your "lucky stars" or whomever or whatever you like to thank when you get dealt a good hand. Because in this instance? You're fortunate. 

Thanks for letting me unpack, y'all.

****

Nor is life.

This past weekend

Harry and I took the kids to this really amazing restaurant in Savannah over the weekend. I don't mean amazing as in "ah-maaaazing" like the foodies say. More in the sense of it being an adventure--like nothing they'd ever experienced.

Anyways. This place was very family friendly and actually had this cool pond built into it where kids could buy a $3 bag of bait and go "fishing" right inside of the restaurant. On this particular evening, we were with a few other families which meant lots and lots of kids having lots and lots of fun.

As the kids fished, the parents enjoyed adult conversation and humor. All of it was wonderful and a great time was surely had by all from the lap babies all the way to the oldest in the group. Laughing out loud and stopping only to occasionally give a kid three more dollars or to take our turns at checking to make sure none of our kids had jumped into that man-made lagoon which, fortunately, no one did.

Finally, we realized that it was getting really late. Even for a Saturday night, we were pushing it for kids this age to be out in a restaurant. We squared up bills and prepared to go and get our respective children.

Zachary was already off and sitting on a bench with some of the other kids as Isaiah and one or two more stragglers held on to their makeshift fishing poles for whatever few seconds they could squeeze out before the bell tolled. Since the other parents were also there preparing to retrieve their own children, Harry focused only on getting Isaiah's attention.

"Isaiah. Let's go."

Harry's voice was firm. Not a yell or even a plea. Just a simple statement with a military man's intonation that said "order" and definitely not "suggestion."

Isaiah and his friends were still in their fishing pole la la land. We'd already given them all several "ten more minute" warnings--probably as much for us and our fun as it was for theirs. But either way, it was late and now, it was time to go.

It really was.

"Okay, okay, okay, Dad. Just let me do this one. . . last. . . thing!" Isaiah quickly grabbed the edge of the line and began to hook another new piece of bait on the end. "Dad, just this one--"

Harry interrupted him before he could even finish. This time his voice was a little more firm than that first time but still very controlled. "Isaiah. Now. It's time to go." The finality in it was clear. I've been at this with him long enough to know that Harry wasn't going to repeat himself--nor would he have to. Isaiah immediately laid the pole down where he found it, said, "Yes, Dad," and began walking toward Harry.

And that was that.

Isaiah scuffled ahead to join the rest of the kids all of whom were now crammed together on a swinging bench, cackling out loud and probably a few seconds away from costing all of us some money, some embarrassment and maybe even an emergency department trip. Harry turned to walk toward the front of the restaurant and just as he did, an older man who'd been watching the entire exchange spoke to him.

"I don't envy anyone who has to get kids away from all of this fun. Especially boys!" His tone was friendly and genuine. He had twinkling blue eyes and the warm, patient body language of a grandfather, which I'm willing to bet money he was. His skin was a sun kissed olive tone with deep crows' feet bursting like fireworks from the corners of those same happy eyes.

Harry chuckled and nodded to him in response. All of it amicable and easy. And that was that.

The man stepped a bit closer and spoke to Harry again, this time more directly. His voice became serious. That said, you could tell it was still well-meaning and non-threatening, especially because of the sparkle that remained in his grandfatherly eyes.

"Mind if an old man gives you a little bit of advice? I mean, just from an old guy who's been around the  parenting block a few times to a younger guy?"

Harry noted his age--I could tell--and paused deferentially. He raised his eyebrows and faced the gentleman to let him know he was listening.

I silently cringed and hoped this wouldn't take a wrong turn.

And so the Grandfather-man spoke:

"You know? If you say 'please' to them now, they'll respect you a lot more when they grow up to be men. Take it from me." When Harry didn't say anything, the Grandfather-man added this, "Just some advice coming from the heart from an older man who's raised up some sons of his own." He smiled at Harry again to make sure that it was clear that this was all goodnatured kindness and nothing more.

And, thank goodness, Harry received as such. No ripple in his forehead or clenching of his masseter; all tell-tale signs of when my husband is offended or annoyed. Nope. There was none of that. Just this inexplicable facial expression and searing eye contact.

Then Harry said this:

"Do you mind if I share something with you, sir?" The Grandfather-man turned his head a bit to the side to let Harry know his ear was bent. And so Harry went on. "I appreciate your advice, but I'm raising my two sons in a world that won't say 'please' to them. Unfortunately, this world just doesn't say 'please' to black boys and it definitely doesn't say 'please' to black men. My sons need to understand that. And they will understand that."

Damn.

I wish you could have seen the complexity of the look on the Grandfather-man's face. His blue eyes became sad in acknowledgement of this very obvious difference in the worlds his sons (and likely grandsons) face and that of this younger man before him. His lips pressed together and his brow furrowed; the Grandfather-man's eyes were still trained on Harry's. And you already know that Harry kept holding that man's gaze as if it were some kind of staring contest.

The Grandfather-man finally closed his eyes and sighed, his entire chest rising and collapsing dramatically. Then he looked back up at Harry and nodded his understanding of the heartbreaking relativity of that lighthearted advice. Heartbreaking, yes, but an inconvenient truth that simply couldn't be ignored.

Especially these days.

And let me be clear:

This was not a negative interaction between a younger black man and an older white man. And this isn't some rant about some uncomfortable conversation laced with racism or any such thing. Quite the contrary, actually. That Grandfather-man came to speak a good word to my husband from the sweetest, dearest place. He did--and my husband (who is usually skeptical of every stranger) would tell you the same.

But.

Without saying very much, you'd better believe that those men had a rich dialogue on race and inequality. Damn, they did.

You see--Harry didn't say it, but he said it:

"If my sons don't learn how to leave when someone says 'let's go', it could cost them their lives. And the chances of someone saying 'please' before beating or shooting them is, unfortunately, low."

And you know what? That's some real talk right there, man.

Messed up, yes. But realer than real.

Now. Do we think our sons deserve to hear pleases and thank yous? Sure we do. Do we also think that, as their parents, we aren't required to spin our rules into requests? You'd better believe it--with all due respect to the Grandfather-man (and to the future respect that could potentially be gained by doing so.)

Harry said he would reflect on that Grandfather-man's advice and remember to be tender at the time-to-be-tender-times with his boys. At which point I reminded him that he is quite tender at those times. Those time-to-be-tender ones, that is.

Yep.

So you know? It sucks, really. It sucks that a black boy standing in the wrong place at the wrong time--even when he's innocent and doing nothing worth even noticing--needs to recognize that sometimes--no, most times--he needs to move on the first time the order is issued. He needs to get moving with as little protest as possible and with or without the "please" or the cherry on top.

Sigh.

Oh. And have we already been having these conversations with our seven and nine year old black men-children at our kitchen table? You're damn right we have. Not because we want to, but because we have to. And if this is something you will never have to think of for your son? Say a prayer of thanks. And if the thought of us and many other families being required to makes you sad? That's okay because it should.

Our kids pleaded to stay and hang out with their friends up until the last second when we loaded them into the car.

"That's not fair," one of the boys mumbled from the back seat.

"Nor is life," Harry replied.

Nor is life.

***

Now playing on my mental iPod. . . . as poignant now as it was when he recorded it. If not more. Listen and reflect on what is happening in the world right now. I'm too sad to specifically address it but know that, like Harry, I just did.




******

And next, this one from May 19, 2014 . . . . . which gives insight of how this sounds from the mouthes of babes.

Sigh.

****

And that's the way it is.

My boy at his bus stop

When you question me for a simple answer
I don't know what to say, no
But it's plain to see, if you stick together
You're gonna find a way, yeah 
So don't surrender 'cause you can win
In this thing called love 
When you want it the most there's no easy way out
When you're ready to go and your heart's left in doubt
Don't give up on your faith
Love comes to those who believe it
And that's the way it is

~ Celine Dion

__________________________________________

She creates a space for those kids to talk about things. No, not just little kid things like Legos and Barbie dolls or Minecraft and rubber bracelets. She gives them permission to speak freely of more salient things affecting the world that they live in.

Yes. That.

So on a carpet in that room, last week she opened a dialogue with those children like she always does. But what that really means is that she carved out some time for an unplanned topic, driven by their first grade ideas and passions. Not so overly planned yet not so loosey-goosey that other things don't get done. Again, just a metaphorical window pushed up high enough for them to breathe and share.

Yes. That.

The "big Martin" he suggested they make. To which she obliged.

On this day, my baby boy raised his hand. There was something on his heart, gnawing at his seven year-old self that he needed to get out and into the open. And so, she gave Zachary the floor and, because of the magic she has already created in that room, he lifted his voice with all ears turned in his direction.

"There is this law in Georgia and in Florida and I a little bit think that it's a not good law."

That's pretty close to what he told me he said to open the conversation. And because this is not the first time I've been blessed with a child in her classroom, I know that she turned her head to him and raised her eyebrows, her nonverbal way of nudging him forward.

"Like, if you see somebody and you think they look like they might hurt you or you feel like they might be a robber or a thief or something, if you have a gun you can shoot them and you won't even go to jail. Just because you think they look like they could be a little bit, um, suspicious."

Yes. Suspicious.

He went on. "There was this boy in Florida. And he was just walking down the street minding his business and you know what? It was raining so he had on a sweatshirt but like with a hoodie. You know, a hood. And this man, he saw the boy and he thought that he looked like he was suspicious and like maybe he could be a robber or a thief. But really, he wasn't. So the man, he like chased the boy and attacked him and then they were like wrestling and stuff. But that man, he had a gun and so then he shot the boy and he DIED. And nothing happened. He didn't even go to jail."

It was raining on this day, too.

And, you know? She didn't have to say a word. Because those kids grabbed that topic and carried it right along on their own. Some were outraged and others were just sort of pensive and thinking. And, okay, we live in a fairly liberal area, but still. I love knowing that these children not only were thinking about important things but that, without having their ideas shaken or stirred, they could. So, yes. Zachary's topic grabbed their interest. Some asked questions that were quickly filled in by other children in the class who knew a bit about this, too.

"The boy, his name was Trayvon Martin," one friend said. And then she--also a first grader--commenced to let the group know a bit more about who Trayvon was specifically. All of which seemed to be accurate.

That wonderful woman who leads that wonderful space that my baby boy calls his homeroom was so in awe that she sent an email to both that little girl's parents and to Harry and me. She told us a bit of the important things our children had shared and how, from the mouths of babes, a rich discussion ensued.

Another bus stop shot

The following morning while standing at the bus stop, I asked my boy about it. I wanted to hear what he said with my own ears and answer any questions he might have. And you know? He repeated the whole story to me. He even said, "One person asked me, 'Why would they think the boy with the hoodie on was a robber or a thief?' and I just told them the truth."  And so I asked him what, indeed, that was. "That some people think that people with black skin might be a robber or a thief even if they're not. That's why it's a bad law because, like, somebody could look at my dad and think HE is a robber or a thief and just take a gun and shoot him. And they won't even go to jail."

Yes. That's what my son said. And so, like her, I said little and let him speak. And honestly, he didn't have a lot of questions, just mostly ideas that he needed to get out. "That's such a bad, bad law, Mom. And it's in Georgia, Mom. That's why I told my class because it's in Georgia where we live."

And I nodded because he's right.

"There's one thing I didn't say, though, Mama. Because I didn't want anybody to feel sad." He craned is neck to look for the bus and his little face grew serious.

"What's that, son?"

"I didn't say it but if Dad saw a man with white skin and he felt like he looked suspicious or something and then if Dad took his gun and shot THAT man then Dad WOULD go to jail. Even though that man who shot that boy in Florida didn't."

I am not kidding you. This is what my 7 year-old son told me in the morning haze as we searched for red blinking lights on a big yellow school bus. "Why do you think that, son?"

"Because," he said. "That's just the way it is."

And with that, he stepped onto Mr. Sanders' bus, waved goodbye and told me to have a great day. My eyes filled with tears as they pulled away. I'm still not sure if they were because of immense pride, immense sorrow, or both.

Yeah.

****

And thank you, Ms. R., for giving my son a place to share his truth that day and for being the same person who encouraged him to learn and sing "Lift Every Voice and Sing" in front of his class.

Now playing on my mental iPod. . . . "That's the Way it Is" as sung by Ms. Celine Dion. (Yes, she annoys me, but I've always liked this song and her voice.) I've heard this on my mental iPod ever since that conversation with my son.

The King's English.

I was thinking about my colleague George yesterday and something popped into my head. This remote memory of a piece of writing that George had sent me a few years ago. When I saw him the day before he sent it, I recall him saying,"I decided I'd channel my inner Kim Manning and write down my reflections." That last part was laced with sarcasm.  Full emphasis on the word reflections. Ha. I could tell from his crooked smile and the twinkle in his eyes when he said it that he was poking fun at me. But I could also tell he was serious, too. "It's just a few thoughts I've been having," he went on. "Like you, I love working at Grady. So I knew you'd appreciate it."

He was right.

Now. The big joke with me and many of my colleagues is that I'm such a tremendous electronic hoarder. I save emails upon emails and constantly appall people by the number of items in my inbox. (Greater than one thousand on any given day--gasp.)  I replayed that exchange with George and, being the electronic hoarder that I am, subsequently began hunting through my giant email hoard piles for that original message--fully believing I would find it.

Mmmm hmmmm.

Did I mention that it was sent roughly four to five years ago? In like 2009 or 2010? Um yeah. Well. Believe it or not, it wasn't out of the question for me to think I'd have it. (Don't judge me, please.) 

Man. Imagine how sad I was to find that, probably in one of my massive vow-to-do-better in-basket sweeps, (usually prompted by someone judging my in-basket number) I must have deleted it.

Booo.

That said, being the multi-level electronic hoarder that I am, I had one other Hail Mary idea still in my back pocket. Yes people. My electronic hoarding exceeds the confines of Emory Outlook.

Mmmm hmmmm.

And so. My Hail Mary plan was to search for the piece in my random hard drive files, fingers crossed that it had been sent as a separate Word attachment.

And guess what? It was sent as a separate Word document. And guess what? That document was in the hoard pile. (Next to a residency recommendation letter for a medical student who is probably a full professor by now.)

Ha.

Imagine the gift it was to me to read these words. Ah! Words my colleague had shared with me way back when. Words that now serve as a haunting opus. . .so defining of his commitment to Grady Hospital, to our underserved patients, to our learners and to the purpose-driven life George tried to live. It gave me chills to read them again.

As I did, I could hear his silky accent saying each line. Using, as we used to joke in clinic, "The King's English." All of this--these words, this melodic use of our language--represented his international background built by living everywhere from India to Kenya to Indiana to Atlanta.

"In Africa," he used to say, "when you learn English, you learn it in its purest form, Kim. It is the King's English. Full strength. Like heavy cream, not this skim milk you hear elsewhere, Kim." When he said that, his eyes were probably twinkling with that same serious-sarcasm and he was likely crookedly smiling once again.

Ha. That makes me chuckle because I can see it. And those who knew him, I'm sure, can too.

Ha.

The original Grady. George would like this photo and would likely know some random fact about it. Ha.

The version I found had minor edits that I'd made out of habit more than anything else. I think George had written this "just because" and don't recall him saying he intended to submit it to a journal for publication. After finding it, I considered sending it off to one, but didn't want to be forced to edit his words too much. I do recall him complimenting this blog several times so have taken license to share his words here.

My honest guess is that George would have been honored to have others read his reflections. I'm proud that he trusted me with them and that he'd taken a moment to "channel his inner Kim Manning."

Ha.

Perhaps after reading this, you will be as compelled as I was to channel more of your inner George Mathew. To find your sense of purpose and then walk into it boldly. Just like he did.

George in his element, with colleagues and learners caring for patients at Grady.

(And if all that sounds too heavy for you, just try using the King's English. He'd like that.)


Enjoy. And thank you for sharing, George. This and yourself.

Your colleague,

Kimberly

_______________________________________________

A Sense of Purpose


I saw him at the hospital curb waiting to cross the road on his way to clinic. He waved at me and after exchanging a few pleasantries, went on his way to the clinic. Watching him stride away, I saw in his steps a sense of purpose.

Pushing through the doors of the hospital, I ran into another of my colleagues. She chattered about the weather, the weekend and while walking with her to the clinic, I could sense she was looking forward to spending the day with her colleagues, residents and taking care of indigent patients, that she called  “a wonderful population."

Combined they had spent over 25 years at the county hospital and had no plans to leave. Every day, every year they had a renewed sense of purpose that only got stronger. A sense of purpose that they were going to be there for the care of society’s most vulnerable.

I count it fortunate to have worked in the county hospital environment. For the academic clinical internist, a county hospital is a satisfying mix of patient care, education and research. Bereft of a strong subspecialty presence, internists tend to thrive in that particular microcosm, whose environment tends to nourish the physician’s soul. Where one physician may see frustration and despair, the county hospital internist sees opportunities for improvement and hope.

Certain specialties have their own favored clinical setting .For the cardiologist and the cardiac surgeon there is the Heart Hospital, for the Orthopedic Surgeon an orthopedic hospital but for the academic clinical internist it is the teaching hospital--often a county hospital. A natural fit.

One of my favorite professors had such a strong sense of purpose, that after serving many years in a county hospital, he went to Africa to create one of Africa’s largest HIV networks. Some of his fellow colleagues followed him there, knowing that a common sense of purpose would unite them as they tackled one of mankind’s deadliest scourges.

Which brings me back to the topic -- "a sense of purpose." For the physician it is the sixth sense, a sense that guides and defines us as we try to take care of our fellow human beings. If ones sense of purpose is followed and not ignored, it can lead the physician down a path where the reward is not monetary or power but one of accomplishment and contentment.

Sadly, in today’s world, many physicians tend to lose this sense of purpose due to a variety of reasons. Most of the time it is the environment in which they choose to practice.  An environment that does not nurture one's sense of purpose will only dull it over time.

But when that sense of purpose is incubated in the right environment, the result is uplifting. A renewal of youth occurs on a periodic basis and the physician continues to enjoy medicine as much as he or she did when they started their first year of medical school. And when others with a similar sense of purpose work together in that same environment, spontaneous chemistry develops. It is highly contagious and results in a deeper and richer environment that most people and professions aspire to but few will ever attain. It is in the county hospital that the academic clinical internist can best hope to create that magic.

~ George Mathew, MD

Written by George Mathew, MD  (1971 - 2014)
Emory University School of Medicine
Grady Memorial Hospital
(Shared in 2010 with Dr. K. Manning and posted with very minor grammatical edits)

***

Happy Monday. Again. And shout out to all the electronic hoarders.  #validation

With Kelly A., one of George's small group students. We promise to take good care of them, George.

What gives YOU a sense of purpose? 

Are you doing it? If not, why?

First Person Chronicles, Chapter 3: Me and Mrs. Jones.

*with minor exceptions, all people included are fictional. The hypothetical experiences are based upon my own observations.

The Unit Clerk

"Miss? Where can I find some gauze and some scissors?"

I was actually on hold with radiology when I heard his voice. Just as I started to address him, someone came in on the line to answer my call. I held up one finger, looked up and smiled. Then I mouthed to him, "Give me just one second." He didn't seem to like that.

"I really need some gauze and scissors now," he repeated. That "now" had a huffiness to it that caused my brow to furrow. I mean, was someone bleeding to death as he stood there? Or had he just decided that his time was exponentially more important than my time--or even the time of the other person I was assisting? "Who is my nurse?" he demanded once more. "I mean, the nurse taking care of 15 bed one?"

At this point he made it clear to me that he was gong to keep hovering right there until I stopped everything to help him. Now I was on hold again with radiology as they looked to see where a patient was and whether transport had picked her up already. I took my chances and put them on hold with me, too.

"Mrs. Okeke." I had checked the board behind me that very clearly indicated who the RN was caring for his patient. The same board he could have looked at. I decided to be a bit passive aggressive when I said it by pointing at the white board.

"Who is that?" he countered without even trying to think more. Just then, Mrs. Okeke walked up.

"This is Mrs. Okeke, " told him while gesturing in her direction. "Okeke, this doctor needs some help with 15 bed one."

He immediately butted in. "I need some gauze and some scissors."

That's it, that's all. No "good morning." No "excuse me, can you help me." No nothing.  Mrs. Okeke just walked off toward the PIXIS to get him what he needed. And that was that.

Just then I remembered radiology and tried to return back to the call I was placing. Before I could, someone else approached the station. "My daddy is cold. Don't Grady have more than just one blanket they give people?" For a moment I wasn't sure who this young woman was speaking to. But then, after a few seconds, it clicked for me that she couldn't be speaking to anyone else but me, the unit clerk.

"Ma'am?" That's all I could think to say. She was clearly frustrated. I needed to prepare myself.

"My daddy is seventy five years old and he in there with just one blanket. He's cold! Can't he have more cover?"

"I don't think that should be a problem. Let me call someone for you."

And with that, she just walked away. No "thank you," no "preciate you," no nothing.

"Is it time yet for me to get something for pain? I'm in pain." This was Mr. Marshall who, every few hours, was at the unit clerk's station asking this same question. His IV pole was right next to him and he still had on his hospital gown. Like always.

Sometimes he started out super, syrupy sweet, complimenting my hair and my skin and then asking me to call his nurse. Other times he was volatile, banking his adhesive taped hand on the counter and gnashing his teeth in my direction. But most of the time, he was somewhere in the middle. Too exhausted to put on a show or rather,  just forgetting. "It's only been about two hours, sir."

"Well, can you call my nurse to come and see me? I'm in pain," he said. His face twisted up and he slumped his shoulders before slinking back toward his room with the IV pole in tow.

Sigh.

I put my hand on the receiver of the phone once more and prepared to call radiology back. Then came that booming voice overhead and those sirens.

"CODE BLUE, SEVEN A. CODE BLUE, SEVEN ALPHA!"

I had noticed a little bit of commotion down on the tail end of the long hall but didn't realize that it was a code situation. Mrs. Okeke came bursting out of room 15 and all of the other nurses began running toward room 26. The rude resident with the gauze ran out next and seconds a later, more doctors of various levels came pouring out of the stairwells and hallways into the corridor.

"Where is it!?" one yelled in my direction.

"26!" I responded.

The entire area outside of the door of room 26 was swarmed with people. Some walking in, some walking out. Some yelling, some looking terrified. And me, I just braced myself and waited for all of the orders that would surely be coming my way.

Whether the patient made it or not.

See, for the clerk? A code means entering orders and making calls. Where those orders and calls go depends upon the outcome. Either way, people often come out of those crazy situations flinging orders like frisbees at your head.

No "please," no "thank you," no nothing.

Which, I guess, I can maybe allow if someone has died. I mean, maybe.

I look at my census to see who is in room 26. Oh no! Sweet Mr. Shaughnessy! Oh no.

I wasn't sure of all the medical parts of what was going one with him. All I knew was that he was homeless, had some psych problems and some kind of medical issue that had made him a real, real long term player. He didn't come out of his room much during the day. Only in the evenings, when things were more quiet. And when he did, he was kind to me. Really and truly kind.

His hair was always matted and he smelled a little bit whenever he came out to the desk. His teeth were all cracked and blackened and his beard so nappy that it resembled taco meat pasted to his face and neck. But that part didn't faze me so much. It didn't. I loved the way he always remembered my name and how, despite his circumstances, seemed to be able to find a glimmer of light everything. I know for sure that he knew my name because every time he approached the counter in the late afternoons or evenings he'd sway from side to side while holding his IV pole like a microphone. Then he'd croon in a really low voice,  "Meeeeee aaaaaaand Mrs.-Mrs. Joooooooones. . . we got a thaaaaaaaaaang . . goin' on. . . . "

And each time I'd just laugh and laugh. Some might have thought he was being fresh, given the nature of that song. But not me. To me it felt like a hug and a big pile of all the "thank yous" and "good mornings" that I hadn't received all day long.

I closed my eyes and said a little prayer for him.

"My daddy stil didn't get no blanket," the same woman said to me. My eyes flung open and I stood up.

"Let me help you," I said. Quickly, I headed over to the laundry cart and slipped a clean blanket out of the stack. "Here you are, ma'am." She took the blanket and marched away, mumbling under her breath something not-so-flattering.

No "thank you," no "preciate you," no nothing.

The phone was ringing when I returned to my desk and from the corner of my eye, I could still see the people milling around room 26.

"Unit 7A, Ms. Jones speaking,"I answered. The person on the other end was a family member of a patient. A seemingly angry one who wanted to know what was going on with a loved one.  Carefully, I did what we are instructed to do, determine who the person is and contact the nurse. But with the code going on, I'd just have to take a message.

"Who am I speaking to?" the person demanded to know.

"I'm Ms. Jones. The unit clerk."

"Well. I need to speak to a doctor or a nurse. Right now."

"Um, okay. Well ma'am, we have an emergency on the floor right now and her nurse is occupied. I can have her call you right back. You said you're her daughter, correct?"

"I'm like a daughter to her, yes. I need to know what's going on right now. I'll just hold."

Like a daughter? I leaned back in the chair and rolled my eyes a little while the receiver was away from my face.

"Ma'am, I will have the nurse or doctor call you back once we get the permission of the patient. Thank you for your understanding."

"This is some bullshit!" the lady on the other end said. And then she hung up. On me.

Sigh.

I looked back down the hall and hoped poor Mr. Shaughnessy was okay. I wished that call had been for him and wondered who would arrange a funeral for him if he passed. I decided that I would go if there was one. To his funeral.

Suddenly, everyone came walking out of the room toward the unit station. Mrs. Okeke was reaching into her pocket for meds that she was obviously about to pass before and the rest of the staff all seemed to be returning to what they were doing. The doctors, even the rude-gauze-and-scissors dude, all walked right by my desk with these nondescript looks on their faces. I couldn't tell from looking at anyone whether or not Mr. Shaughnessy had made it.

So much energy. No answers. No nothing. Chaos one minute, business the next.

I closed my eyes once more and said another little prayer for Mr. S.

"Good morning, Ms. Jones."

That nice greeting--by name--startled me. I looked up and saw the smiling face of what appeared to be a young doctor. I tried to place her--I think she'd been a medical student here first and had stayed on as a doctor. I could usually tell by the length of the white coat which, right now, I couldn't go by since all she was wearing was a set of blue scrubs.

"How are you doing today?" she asked me still smiling. I noticed the tiny freckles spread across her nose and the color of her eyes. Some shade of greenish-blue.  I smiled back.

"Good. Crazy morning."

"Yes, indeed," she replied. "You look a little distracted. Are you okay today, Ms. Jones?"

I felt bad for not knowing her name. But the fact that she'd made up her mind to not only learn my name but use it, spoke volumes of who she was. Though I couldn't place her name, I recalled the team she was on as a student where her attending, Dr. Winawer, always spoke to me in front of all of them. I think she'd learned from that example. Which I appreciated.

"The patient who coded has been here a while. He's such a nice man. I was just feeling a little worried, that's all."

The freckle-faced intern reached out her hand for me and touched my arm. "That's so kind of you," she said softly. "Well, I'm on the ICU team this month. And I want you to know that I'll be taking care of Mr. Shaughnessy up stairs, okay? We got his pulse back and it looks like the nurses called the code so quickly and started compressions so fast that it made a difference. Of course, he's sick. But we will take good care of him, I promise." I could tell that she meant that.

"I'm so glad."

She nodded and began to walk backward toward the room again. Then she stopped and said, "Oh, I almost forgot and I've been meaning to ask. Did your daughter make the dance team?"

I was confused for a moment and then remembered telling Dr. Winawer about my daughter trying out for her high school dance line last year. She was a student and was there and remembered. Which immediately made me feel like crying and laughing at the same time. "She is the captain this year. Her and another girl."

The freckle-faced intern gave me a big thumbs up and shuffled back over to room 26. And that was that.

"Is it time for my pain medicine yet? Is it?!"

It was Mr. Marshall again. This time he was angry. He slammed his hands on the counter in front of me.

"I'm sorry you're in pain, sir. But it's only been a few moments since the last time you were here."

"CALL MY NURSE!" he snarled.

I didn't say another word. I just sat still for a moment. From the corner of my eye, I noticed the bed being wheeled out with Mr. Shaughnessy on it. Someone was bagging him while the freckle-faced intern was holding his the rail of the bed helping guide it. When she passed me, she gave me another thumbs up. "Bye Ms. Jones!" she said. "Thanks for your help!"

As they disappeared down the hall, I realized that I hadn't done anything for her. But that she seemed to appreciate the fact that I stood ready to.

Sigh.

That little bit, that tiny humanistic nod from that intern did my heart good and had given me the charge I needed.  I looked up at Mr. Marshall and softened my expression. "Good morning, again," I said, "Let me see if I can somehow help, okay?"

And he nodded his head and let that angry fire quiet down. Instead of getting his nurse, I put my hand on his back and walked him back to his room. I told him it would be okay and that I'd make sure his nurse knew he was in pain. And that? That seemed to be enough.

Surprisingly enough, it was and all he really wanted after all.

Two lines were ringing when I got back to the desk. One of which was radiology asking why I'd hung up on them. Another resident doctor was asking for something without making eye contact with me.

"Who is O-KEEK?" she asked while looking a bit annoyed.

"Mrs. O-KAY-KAY is right there. Would you like me to get her attention for you?"

That annoyed resident just walked off while muttering what I think just maybe was a thank you. Maybe. She obviously hadn't been on Dr. Winawer's team. Oh well.

Also a patient who was recently discharged was standing at the counter with a prescription that she couldn't afford to fill. I wasn't sure how to fix that, but figured I could at least say I was sorry and get the doctor. Which seemed to make a difference.

I paused for a moment, just long enough to hear Mr. Shaughnessy with his crackly voice singing quietly in my ear and then I smiled, thinking about the care I know for sure that the freckle-faced intern would give him. I knew he was in good hands.

Why?

Because she noticed me. And if she noticed me, then she'll notice him. And to me, noticing people is like telling them they matter. And that you care.  Which, if you ask me, is more important than just about anything else when you're working in a hospital like Grady.

I returned to my work--answering phones and answering questions. Some people were nice to me and some weren't. But me? I made up in my mind to notice them all no matter what. . . .

. . even if they hadn't yet made it up in theirs to notice me.

***
Happy Monday. Will make up for Sunday with two today. Stay tuned.


Now playing on my mental iPod. . . . for all of the wonderful unit clerks at Grady who deserve to always, always be noticed. 

Stay Gold, George.

Isaiah helped me edit this picture. He said, "Add a happy face because I can tell he made people smile."

Seize upon that moment long ago

One breath away and there you will be

So young and carefree

Again you will see

That place in time. . . .so gold

Steal away into that way back when

You thought that all would last forever

But like the weather

Nothing can ever. . . and be in time

Stay gold

But can it be?

When we can see

So vividly

A memory

And yes you say

So must the day

Too, fade away

And leave a ray of sun

So gold

Life is but a twinkling of an eye

Yet filled with sorrow and compassion

Though not imagined

All things that happen

Will age to old

Though gold

~ Stevie Wonder

_____________________________

I listened to this song tonight and quietly wept. Especially the stanza that says:

Life is but a twinkling of an eye
Yet filled with sorrow and compassion
Though not imagined
All things that happen
Will age to old
Though gold


Life truly is just that. But a twinkling of an eye. Today I sat on a hard pew in a church. Along with throngs of colleagues, medical students, residents and others, we paid respect to a dear colleague--a golden colleague--who, unfortunately, left us long before his golden years.

Yep.

A team on call couldn't get their attending on the phone. An attending physician who took great pride in caring for his patients at Grady Hospital and who would never leave them high and dry without some good explanation.

When Deanna didn't pick up our kids from after school care on November 15, 2012, I remember uttering aloud to Harry over the phone: "Over her dead body would she leave those kids without calling us." Well. Unfortunately, this was a nearly identical situation. Over his dead body would he leave those patients at Grady.

Sigh.

He was young. Presumably healthy. Cherished by many. And now, in the twinkling of an eye, he has made his transition. Some kind of natural cause, although the timing seems horrifically unnatural. This wasn't supposed to be what I was doing today. No, it was not.

Last week I sat in a meeting with him. Last Thursday evening to be exact. We were about to start a project together with a group of others. The meeting was going over and I whispered to him that I needed to get my kids. He calmly said, "Don't stress it, Kim. You should go to your children. I'll fill you in on the details later."

And you know what? He did.

I guess you'd think that something like this--a young colleague in his 40's having some kind of sudden death after what seemed like an ordinary day--would take me to a dark place. Or at least rip the scab off of my own wound. Particularly since the last time most of my colleagues saw him in the hospital was on November 15--coincidentally the day we said good bye to Deanna. But you know what? It didn't. It broke my heart, yes. But somehow I felt my heels digging down into the ground of my life and the people in it. Reminded, yet again, of that truth Stevie Wonder sings of so hauntingly:

Life is but a twinkling of an eye.

My colleague, George? He lived life like it was golden. He did things with zeal, marched to his own drum, and didn't waste a lot of time worrying about what everyone else thought. He was a dedicated teacher, mentor and friend. A Grady doctor through and through and also a small group advisor who will be survived by four doting small groups of former and current medical students--all broken hearted and reeling from this tragic loss.

But.

Life is but a twinkling of an eye. And somehow George must have known that, too. He left it all on the field. And man. You should have heard the words spoken about him today. I heard someone wise once say, "The value of a man's life is measured in how much of it he gives away." Listening to his family, students and colleagues talking about him today was a clear affirmation of how rich of a life he lived.

I hated seeing his small group students crying. I just hated that part. It also hurt to hear the restrained pain that kept eking out between the words his young niece spoke on behalf of their family. That part felt like deja vu.

Anyways.

Here is yet another charge to us all to live life like it's golden. To love like you mean it. To try the things that seem out of your reach. And to be as intentional as possible. And to not bog yourself down in what other people might think. My friend George did all of these things.

This evening I was running in silence (and actually darkness.) I love stillness like that because in it I can hear and see things that normally I'd miss. This time, I could hear George with his silky accent saying something wise about all that transpired today. Shrugging and saying in his relaxed way,"You know, Kim? Here's the thing: Death brings life. Like, a seed is planted and grows. But only after it has fallen from the tree. You know?" And I smiled and even laughed while I was running because this is the kind of thing that he'd totally say. Something deep, cryptic and Yoda-ish like that-- and words that would make you think for a moment and then say, "Aaaaaaah" -- like 45 minutes later. Ha.

That was George.

He wasn't a father or a husband and his parents preceded him in death. That said, he was a true family man. A doting uncle and so open and giving to all of us. He understood the importance of family and I know that first hand. He always, always helped me out when I asked for a colleague to cover me or when I needed to get out early to get to my children. "That's important, Kim," he'd say. "Go ahead. Get to Isaiah and Zachary." He'd call them by name, too. Funny how the little things become the big things, right?

Sigh.

Again. . .life is but a twinkling of an eye. Tonight I'm reflecting on those words and the life of my colleague and friend, George Mathew. And feeling glad that I had the chance to know him.

And yes you say

So must the day

Too,  fade away

And leave a ray of sun

So gold

***
Stay gold, Georgie.

Now playing on mental iPod. . .and on my real one tonight. . . Stevie singing "Stay Gold." When I see a ray of sun, I will think of you, George.

First person chronicles, Chapter I: Urban legends.

It isn't like they say it is, you know. Like, this whole urban legend of it being like someone stuffing you into a cannon and exploding you straight out into the sky is actually just that. Legend. I think the folks who never tried it before are the ones that make those kinds of stories up.

Like just yesterday when I was on the MARTA train and heard some older lady talking about how people who smoke rock do it because they're always trying to chase that very first high. "It's like they go crazy, " she told her friend. Then she went on and on with more bullshit that I'm sure she didn't know first hand. And it was sort of pissing me off the way she kept talking with so much authority like she was the damn Surgeon General on street drugs or something. I started to lean over that plastic orange seat and give her an earful. Like a mean, cussing, one. But instead I just stared straight ahead and spoke loud enough for her to hear me.

"That--what you just said--ain't really true."

She swung her head from side to side like it's no way possible I was speaking to her. So I repeated myself. "That's not the truth what you saying. Obviously, you ain't never got high."

And would you believe that old lady was so stunned that she didn't even bother to respond to what I said? I guess she looked at me and made up her mind not to fool with me. Like a person riding in one of those open door buggies in a wild animal park where you ain't s'posed to feed or touch the wild animals. But me? I ain't no wild animal. Regardless of what I look like, I'm not.

I'm really just a regular person. A regular person who got caught up.

You might define regular as going to college and being filled with what everybody thinks is promise. Well. I didn't go to college but I did finish high school. I had me a good job with some benefits, too. That said, I could still be regular without all that. To me, regular mean you got your head screwed on and you have a damn clue. I did have a clue, too. I did. And I still do.  It's just that over time, I got caught up. And now I'm like I am now.

Anyways.

I had just got off the MARTA that day when I started to feel I was losing my breath every time I tried to walk. I'd walk for like a few feet then have to stop. Then my chest started tightening up. I knew enough to get back on and ride down to the Georgia State station right by Grady. With what I'd smoked that morning, I wasn't sure what this all meant but I wasn't gonna wait forever to find out.

Most of what they said flew over my head. I guess they think I had a light heart attack and all of it they relate to me smoking. So they talk at me and scold me and all that like that's all it would take. And me, I just sort of tune it all out because it's almost as annoying as that old lady on the MARTA.

There was one person I liked, though. This little medical student who works with my doctors came in my room every day asking me all about my life.. Like, she wanted to know about the first time I ever used crack and like, what all was going on when it happened. She seemed like she for real wanted to know, too. Then she made a reference to that same thing everybody is always saying that ain't true about running behind that first big rush.

"That's not how it is," I told her.

Her eyes got all big like saucers. Then she said, "Tell me, then. What is it like?"

I sat and thought on it for a few seconds then I asked her a question. "You ever had sex with somebody that you know you ain't got not business having sex with?"

Lawd. What did I ask that for? That child turned fifty shades of crimson when I said that. And I swear I wasn't trying to embarrass her. I was just trying to find an analogy that fit and, hell, she looked grown. At least, grown enough to be in medical school which means she already went to college before that.

"Look," I went on without making her answer, "it's kind of like the first few times you have sex with somebody. Especially somebody that you ain't got no business getting with. The first time, it's mostly that you are caught up in the moment or curious. It's not necessarily great but you find yourself thinking about what you did. Next thing you know, you made up your mind to try it again. 'Fore you know it, you can't stop yourself."

"So . . .  no crazy fireworks? Or like a really intense first high?"

"Naaaah. That's that bullshit people always feeding the world about crack. It ruins your life slowly. Like somebody ripping pages out of a book or pulling hairs from out of your head. Take you a minute to notice, you know? But once you do? Man."

She got that. It made sense to her and I could see her wheels turning.

That medical student sat and talked to me for two whole hours. She made me feel better than anybody else on that team. Maybe since she was't busy or maybe it was just that she knew how to not seem busy that I liked her.

She came back and told me that I didn't have a full on heart attack. The heart doctors had thought about having me do the test that checks to see if you have blockages in your heart vessels. But then when they heard I was still using crack, they shifted the plan. At least that's what I think.

Now, I get to go home. Which, at the moment, I'm not so sure what that's gonna be. And even that, not knowing where you really live, isn't like what people think. But that's another story for another day.

So anyways. My point in all of this was really just for you to know that the only way to know about the  real deal stuff happening with real patients is to just ask them. And if you want to know the real parts of the things that are mostly urban legends, it's best to ask the legends themselves. You find out some cool shit that way.

I'm just saying.

***
Happy Thursday.