Top Ten: Bye Felicia!

Okay, so check it. The other day I was talking to one of my two Grady BFFs and uttered this slang statement in passing. I could tell from the expression on Lesley's face that she wasn't familiar with that phrase, although the contextual clues mostly gave it away enough for her to follow me. What's funny is--when I said it, it didn't even sound like slang to me. Well, wait. I take that back. It did, but I guess when I am speaking to black folks, there is just this understanding that some words and phrases we all just sort of know.

Now.

Let me just be clear on one major caveat. There IS a genre thing with a lot of this stuff. So, yeah, there will be things my mom and dad will have NO idea about that my siblings completely follow. And since my friend Lesley is my age, that got me thinking. And since I am so very dedicated to cultural competency, I thought this would be a great time to pluck this into a little top ten while watching the Oscars. Especially since 95% of the following will be exactly what is discussed when I am in the hair salon on Wednesday.

I bring you:

THE TOP TEN PHRASES THAT I ASSUME PEOPLE KNOW BUT AM NOW REALIZING THAT THEY DON'T SINCE EVERY PERSON I KNOW ISN'T A BLACK WOMAN BETWEEN THE AGES OF 25 AND 55 NOR A PERSON WHO FREQUENTS MY HAIR SALON.

Like to hear it? Here it go!

Hey:  For funsies--let me know how many of these you were familiar with and have used and share your score.

#10  Phrase: "That's a good look." 

No, this is not referring to your outfit or new hairstyle. This phrase refers to anything that relates to something that goes in your favor, particularly when another person has assisted in making said thing happen.

"Hey! I thought you had to work today and couldn't come to the Oscar watching party!"

"At the last minute Shanta agreed to cover my team. And said I don't even have to pay her back."

"Damn. That's a good look, dog." 

"I know, right?"

Or

"Where are your kids?"

"Girl, my mama agreed to keep them for the whole three-day weekend."

"Dag. That's a good look right there."

"No doubt."

#9  Phrase:  "I ain't even mad."

Does this mean that your spouse can relax since you are in a good mood? No, not at all. This is just a way of saying that you don't blame someone for doing something or that you approve of whatever it is they've decided to do. Let me make sense of it.


"I traded in my SUV for a two door Kia."

"I ain't mad at you for that. Gas is expensive."

"Well, not really anymore. But it might get expensive again."

"Fo sho."

Or

"Did you see Bruce Jenner on the cover of People? He's transitioning to a female." 

"You know what? I ain't even mad at Bruce for that. You gotta live your life and be true to who you are."

"I feel you  on that."

(Hmmmm. That reminds me that "feeling" somebody should be added, too. But you get the point.)

#8  Phrase: "That face was beat."

Just literally said this to a friend tonight. On social media while watching the Oscars. Did the woman to which we were referencing have a black eye? Nope. Quite the contrary. "Beat" refers to someone having a perfect application of makeup. Either by a professional or by their very careful hand.

"I didn't like that dress Kim Kardashian wore on the red carpet."

"Yeah, but that face was BEAT though."

"BEAT, girl."

"All the way down, chile."

And tonight:

"Jennifer Lopez looks pretty tonight."

"And that face is BEAT, do you hear me?" 

"Girl, what you saying! That make up artist beat her unconscious, chile!"

(These are the important exchanges I have during awards shows.)

#7  Phrase: "Bye Felicia!"

Sigh. Where do I start? Okay. So there's this cult classic movie that many of you are already familiar with called "Friday." There is this one scene in it where this neighborhood nuisance is bothering Chris Tucker and Ice Cube and as she keeps trying to talk to them, they finally end it by saying, "Bye Felicia!" Somehow, someway this became the way of telling people to shut up and keep it moving. Particularly when they are talking nonsense or are just working your nerves. Google "Bye Felicia" just for kicks.

"Did you hear Sarah Palin talking on TV the other day?"

"Mmmm hmmm. And I was like, 'Bye Felicia!'" 

"Me, too, girl."

Or

"Some man was on the cover of USA Today with a shirt on that said, 'I CAN BREATHE.'"

"Anyways. Bye Felicia!"

"I know, right?"

Also see: "Girl BYE!" (similar use)

#6  Phrase: "I feel some type of way."

This is actually the one I said to Lesley. Ha ha ha.

Sigh. This is a line from this rap song that is aptly titled "Feel Some Type of Way." I have no idea what the song is really about. But the term "feeling some type of way" has stuck and is used to describe any complex emotion that you can't place a finger upon.

"Did you go out with him again?"

"Naaaw girl. He kept texting somebody on our first date and I felt some type of way about that."

"Yeah. Not a good look, girl. I ain't mad at you for that."

Or

"Girl, let me get to my mama to pick these kids up 'fore she feel some type of way about me being late."

"Yeah, you better hurry up, girlfriend."

#5  Term: "Crumbsnatchers"

A universal term known by black folks to describe small children. I've mentioned it on this blog before so don't count it if you learned it here.

"Did you invite Jane to brunch?"

"No, girl. She always springs her crumbsnatchers on you at the last minute."

"Ooooh. So true. Not a good look."

#4  Phrase: "He could get it."

Ha ha ha. I am adding this one against my better judgement. This is the term used to describe any person--usually a celebrity--who is extremely attractive.

"OMG. Mark Ruffalo didn't win the Oscar!"

"Yeah but Oscar or no Oscar, he could definitely get it."

"Fo sho."

Or, while watching TV with the BHE:

"You know? Jennifer Anniston could get it."

"Oh yeah?"

"Her and Eva Longoria."

"I can see that." 

#3  Phrase:  "Sit down somewhere." or "Take several seats."

Ha ha ha. This funny little phrase is used a lot of ways. But mostly when you are tired of someone or they are just doing too much. Sometimes they deserve this phrase but sometimes they don't. Case in point:

"Ugggh. LL Cool J is hosting the Grammys again? I wish he would just sit down somewhere."

"I know, right? Him and Jennifer Hudson."

"Ha ha ha ha, I know! She sang the first two notes and I was like, 'Bye Felicia!'"

"Yeah, chile. She needs to take several seats."

LOL

#2  Phrase: "I'm cool."


Not like you think. This describes somebody or something that you've put on ice or a relationship you've redefined. Usually out of awareness or necessity.

"Would you like a Bloody Mary with your omelette?"

"Naaaah. I'm cool on vodka. It gives me a headache and a hangover."

"Gotcha. Hey, why weren't you at the book club yesterday?"

"I'm cool on that book club, man. The woman who organizes it said something crazy to me and I felt some type of way about it." 

"Awww damn."

"Plus I didn't read the book anyway."

#1  Phrase:  "I can't."

This is one of my absolute favorites. "I can't." The phrase for when you are at a loss for words at something being so foul.

"Oh Lord. Is Lady Gaga about to sing The Sound of Music? I just can't, girl."

"She sounds good to me."

"No way. She needs to sit down somewhere. Honey, I just can't." 

"Really? I thought that was a good look for them to have her sing that tribute!"

Bonus:

Phrase:  "She DID that."

Emphasis on DID. Anything someone did really, really well, you say it just like that. Especially if it is remarkably better than anything else you've seen in a long time. Case in point:

"John Legend and Common sounded great at the Oscars!"

"Yeah, they DID that."

Or

"I love those photos from your birthday party, girl!"

"Thanks!"

"Who did your make up? That face was BEAT, do you hear me?"

"I did my own make up!"

"You did? Even the lashes?"

"Surely did."

"Damn, girl. You DID that."

LOL LOL

See? I don't make this stuff up.

You are now officially ready to go with me to the hair salon this week. Woo hoo! I know I forgot some good ones but this is a start.

How'd you do? 10/10? 5/10? 0/10? What say you?


***
Happy Sunday.

Shut up and dance.

Five days you work

One whole day to play

Come on everybody

Wear your rollerskates today

It's Saturday, Saturday

Saturday, it's Saturday

Saturday, it's Saturday

Saturday, it's Saturday

~ from De La Soul

I love being on the inpatient hospital service. The acuity of the patients, the energy of the wards, and just the dynamic of working as a part of a team just does it for me. Seriously, if it weren't for the fact that being on the hospital service also means working weekends, I'd do it year round.

Yup.

One of the best parts for us medical nerds is the fact that we get to do a lot of teaching when on the hospital service. The potential teachable moments are endless, man--especially at a place like Grady. But you know what? One thing I have learned is this: Not every moment is a teachable one. That is, in the literal sense. Sometimes the teachable moment is identifying the moments when it really isn't one.

Yup.

I know that probably didn't make sense, so let me explain. Matter of fact, why not reach back to the source of that lesson--my residency. Since I've been on a bit of a roll with my tales from the residency crypt, I may as well keep it going, right? Ha. Don't mind if I do.

The Unteachable Teachable Moment

My residency training took place before there was duty hour reform. In other words, how many hours we worked in a week or consecutively never seemed to be fully factored into anything we did. In some ways, it afforded us great experiences as learners. But a whole lot of other times all it meant was that  you were guaranteed to be in an exhausted stupor at some point. And how that stupor looked depended upon the person, the call and the location in the hospital.

Yup.

I will never forget this one morning on rounds in the Pediatric Intensive Care Unit (PICU).  I'd been up all night long without even a few moments to catch my breath. The kids on the unit were sick-sick--I'm talking tenuous and teetering on codes well into the wee hours of the morning. It didn't help that the PICU was, hands down, the most terrifying place in the entire hospital to me. Sure, I learned a lot but the intensity coupled with the nausea-inducing fear that I'd assassinate somebody's child was a lot. Yeah, man.

Well. What I remember the most was that this particular morning on rounds upon which I'm reflecting fell on a Thursday. That's significant for two reasons: The first is that my weekly continuity clinic was every Thursday afternoon. The second was that, because of the fact that this was during the pre-duty hours reform era, I was expected to go to clinic despite having been up all night long with critically ill children.

Yeah.

One of the kids I cared for that night had severe, persistent asthma. A fun afternoon with his family turned into a nightmare when he started having a refractory asthma attack. "Status asthmaticus" they call it; an ambulance whisked him straight to our emergency department who quickly shunted him upstairs to us. His lungs were so tight that he received the entire kitchen sink from the moment he arrived; he even had to have his blood oxygen levels monitored with an arterial line--which isn't an every day thing with kids. Arterial sticks hurt like hell which made my hands super shaky and nervous while attempting to stick him. On top of that, he was only eight or nine years old. God, he was just terrified. With every air hungry inhalation he took the skin over his ribs pulled tightly over his bones like some kind of relief sculpture. I also remember him crying as I stuck his wrist. All of that was right before he got intubated. It sucked, man.

For him more than me, of course, but still it sucked.

That same night, there was another child I cared for that we all knew very well in the hospital. Man, was she cute. Her cheeks always looked like that had a perfect application of blush and the strawberry blond ringlets she'd been born with looked like they'd cost her parents thousands to achieve. But beyond her natural beauty, she also had severe epilepsy. I'd admitted her before for complications of her frequent seizures--usually to the regular pediatric ward. On this night, she was down in the emergency department and the on-call pediatric resident was preparing to admit her for the same. I was called down from the PICU after she suddenly went into something called "status epilepticus"-- a condition where a seizure persists for a substantial amount of time and, in this case, doesn't respond to initial treatment.

We pushed med after med and nothing was working. The pediatric neurologist was en route and the PICU fellow was right there in the trenches, too. The nurses who weren't caring for her comforted her mother, a woman who, by now, was a friend to us all. Finally she had to be put into a medically induced coma. And let me just say that this was some shit I'd only read about on test questions--not actually participated in making happen. By morning, I was metaphorically down on all fours begging the sun to rise into a new day--which would mean a new resident on call.

Yeah.

So the way it worked was that we rounded with the ICU attending the following morning to discuss every single nitty-gritty detail of the overnight events. My attending that month was this really, really nice man who loved to teach in a Socratic style which, usually, I responded to as a resident. But on this particular morning, I wasn't really up for Dr. Quizbowl or any of what would surely be his standard litany of questions.

Now. Let me also just remind you that at 1PM, I was still expected to go and see a panel of seven patients in the clinic. Whenever this was the case, the goal always was to knock every single drop of work out so that you wouldn't have to return after clinic.

Yes. You read that right. RETURN. AFTER. CLINIC. POST. CALL.

The only way this could happen--and I do mean the ONLIEST way on this morning in particular--would be for my attending physician to focus more on the care of the patients than the quiz bowl soliloquy. And NO, I'm not saying that it's cool for things in residency to be all service related and not education related. But what I am saying is that the ground was fallow and not EVEN fertile for a whole bunch of extraneous teaching seeds to be planted. I needed this dude to get down to business. And focus on just the damn facts.

Capisce?

But he didn't. Not one bit. Dr. Quizbowl started first with a bunch of questions about the AV mismatch in asthma and I swear I don't know how, but from there he jumped off into a tangent about fetal hemoglobin and oxygen carrying capacity. Even though this child with asthma was not a doggone fetus or anyone with something warranting that as a discussion at the moment. (No, he didn't have sickle cell anemia, you medical nerds.) I did my best to answer his questions which escalated in difficulty.

Uggh.

Dr. Quizbowl liked to grill only the post call resident. Again, that was usually fine for me but this night was so bad that today it wasn't. I also couldn't keep my eyes off of the clock. I wanted nothing more than to get the plans locked in by 11:30 so that I could tie up loose ends and scoot to clinic.

But then we went to see our sweet curlyhaired girl.

First, he waxed poetic about the mechanism of status epilepticus and what happens on a physiologic and pharmacokinetic level with the anti epileptic drugs. From there he began quizzing me about the mechanism of action of some of the newer agents and then, after studying the vitals overnight, decided he'd start asking me a bunch of pathophysiology questions that I hadn't really thought of in such detail since my second year of medical school. And you know what? I didn't effing know the answers.

I didn't.

Well, I take that back. It was past 11:30 and I was already feeling nauseous from being so tired. While maybe, just maybe, with some thought I could have found some piece of the answers to his questions to at least prime his teaching, at that moment? I had nothin'. The more his mouth moved the faster the clock seemed to tick. Before I knew it, it was already 11:45.

"Why a pentobarbitol coma, Kim?" he finally asked me.

"What?" That is literally what I said in response. Because that was too vanilla a question for it to be almost lunch and too nebulous for me to even hold on to the tiniest chance of me getting any more work done.

"Pentobarbitol. Why do we use that in status epilepticus?"

"Um, to stop the seizures, sir. To quiet brain activity."

"Be more specific. Talk me through what is actually happening in a noisy brain that sees pentobarb. Why is this something we do in this situation?"

And just as he said that, the clock struck twelve noon. I promise you it seemed like it happened in Dolby stereo, too. Honestly, the whole team was shifting between their feet, but lucky for them, they weren't on the hot seat like me. Noon and he was still teaching with no end in sight. It was official. I would have to return to the PICU at 5:30 that evening to finish my work. Even though I'd been up for more than 24 hours at this point.

"Kim?"

"Sir?"

"What say you?"

My eyes began to throb with tears. As soon as my chest started heaving, I knew it was a wrap. My mouth hinged open to talk but only a squeak came out. "Status Postcall-icus," they should have called it.

"Dr. Draper?"

I wiped my hand over my face hard to try to mask the tears that were now falling straight from my eyes to the linoleum floor in big splashes. Shaking my head in embarrassment I responded. "I don't know, sir. I don't. I just. . ."

"Are you okay, honey?" The nurse on rounds with us rubbed my back and tried to console me. She looked over at Quizbowl and added, "On sign out the night nurses told me she didn't sleep a wink."

"Welcome to the PICU," my attending responded with a heartless chuckle.

And I swear to you, that was that. No further acknowledgement of my brief outburst or any such thing. We just kept it moving. Yep. That dude talked and taught for another half hour or so and finally let us go. All I ended up with was enough time to change into my clinic clothes, eat some leftover stromboli from the night before, and hoof it to clinic. And yes, at 6PM I was BACK in the PICU finishing up some notes and trying to stay awake for sign out rounds. While Dr. Quizbowl took it upon himself to make a few more teaching points to boot.

Yeah.

I know that the only thing that allowed me to drive home without face planting on my steering wheel was how resentful I felt of my attending and his irresponsible use of our time that morning. Not only did he not recognize a dangerously exhausted learner in front of him, he also ignored the fact that we needed to transfer patients out, care for new admissions and just get some damn work done. And I wasn't a lazy resident by any stretch either. I loved being taught and guided--and still do. But this day? It just wasn't a teachable moment, man. I mean, not in the way he forced it to be.

I bet you a million dollars that from eleven o'clock on, nobody heard a damn word of what he said. That I know for sure.

Let me quickly contrast this by saying that just a few months later, I was rounding on a Saturday with the chairman of the Department of Pediatrics. The service was busy and he was even busier. That said, he was an outstanding teacher and champion for children's health. And so. I remember him starting rounds that morning by simply saying this:

"It's Saturday. It's busy. And it's Saturday. A Saturday where our team isn't admitting new patients and where the ones we have are primarily stable. The teachable moment this morning is on focus and efficiency so that we can take excellent care of our patients and then leave. Y'all got that?"

And yes, he said "y'all" which he often did. That didn't mean be cursory or rush things. It meant to focus on the essential tasks at hand. It meant that this wouldn't be the day to draw algorithms on the chalk boards or sit the whole group down to review a new article. There were teams assigned to the hospital for the full day on Saturday and his point was that we needed to do our work and then allow them to take over so that we could achieve some semblance of work-life balance.

Oh. That.

Now that? That was pivotal for me. The thing I remember the most was that he was SO right about THAT being the teachable moment. The fact that this wasn't the time for him to review every study he has ever published or to recount all that is in his memory about every subject he can think about. It wasn't.

You know what else? Midway through rounds he looked at one of my post call interns and then interrupted rounds. He pointed straight at him and said, "You. Go ahead and sign out so that you can go home. You look like you're about fall under the nurses' station. Go get rest." The intern just stared at him. He looked from side to side and then repeated himself. "I mean NOW. Leave. Now. Get rest. Your work here is done today."

And yes--we, too looked conflicted when he said that, but nobody questioned the dang-on Chair. See, he was right. That intern was about to collapse on his face from exhaustion and that man had the sense to know it. Then he said to me, "Kim, the teachable moment here is knowing when somebody is on fumes.  Getting him out now means he'll be better tomorrow. Trust me. We can pitch in and finish what needs to be done."

And yes, he said "we." I loved the way he often said "the teachable moment is. . ." That put us all in the right state of mind for whatever it is we were doing. And helped us to see the teachable moment as just that.

I have never, ever forgotten those two experiences. Every single time I am attending on the wards I remember both Dr. Quizbowl and Dr. Chairman--and apply their mighty lessons to the way I manage my own teaching and team management. Yes, in medical education, we walk a fine line between balancing service and education. And, of course, our learners are there for supervised instruction, not just scut work--I get that. I do.

But.

As awesome as the music of medicine can be and as fascinating as the melodies often are, sometimes? Man, sometimes the very best thing that we can do as teaching maestros of this symphony called medicine is simply shut up and dance. . . . .

That, my friends, is sometimes one of the most powerful teachable moments of them all.

Yeah.

***
Happy Humpday. This post made me think of this post on Saturdays, balance, and why it's so important.


____________________________

Every time I round on Saturdays when my team isn't admitting, I think of Dr. Chairman and hear this song in my head. Then I say to my team, "It's Saturday." (Even though I am hearing this song in my head the whole time and feel like I have on roller-skates. Ha!)

But first, here's some proof--I sent this text to my ward team last weekend--complete with a witty emoticon. Heh heh.

Next time I'm just gonna text them this. . . . 

Beyond chocolates and buy-one-get-one-free roses.

"And as the sun starts to rise today, Valentine's Day, 

I know I've just seen what true love looks like."

~ Joelle Rosser, MD

I woke up to the sound of Harry rhythmically breathing. As soon as I stepped out of my bedroom door, I heard more familiar sounds. Zachary was sitting criss-cross applesauce on a bean bag playing Madden Football on the Playstation 4. Isaiah was in the sunroom lounging under a big, fleece blanket, not so much because it was cold but more because blankets just feel good sometimes.

I picked up a sock off of the floor and began making coffee. I opened the fridge and then reopened it again to determine the unpleasant scent that had just wafted out. It was the chicken stew from last week--Ewww. With coffee in hand, I gathered Zachary's uniform for his basketball game and then sat down to check emails for a moment.

One of the first things I see is one with this in the subject line:

"Musings from the hospital on Valentine's Day morning."

Oh snap. I'd actually forgotten all about today being dia de San Valentin until that very moment. In my own defense, we did have an early Valentine's Day dinner as a family at my favorite restaurant on Thursday. I guess that made today feel like a "regular old Saturday" -- which mostly it seemed to be turning out to be.

But then I read that email. It was from one of my former students, Joelle, who is now in her internship on the other side of the country. She'd typed her stream of consciousness into an email after a pivotal evening caring for human beings. And I froze in my tracks after reading her words.

I just want you guys to know that the future is in good hands. The young doctors coming up have hearts the size of Texas and are not in it for the money or the social position. Her words also made me smile thinking, "You can take the doctor out of Grady but never the Grady out of the doctor." Never.

Joelle was kind enough to allow me to share her words here today. I can think of no better way for this Grady doctor to honor this day that is supposed to be about love than to post these reflections on its true meaning. Love, that is.

Thanks, Joelle.

_____________________________________________

Reflections of an intern on Valentine's Day morning

It's 4AM. I'm working the night shift for the oncology service. I've taken care of everything for my new admissions and most of the other patient's I'm covering for are sleeping without any active issues. I have a few minutes to breathe. To check in on a few patients. To think about what it is that I'm a part of tonight. I visited Mr H.

Last night I spent most of the night watching his blood pressure teetering on the edge of requiring a transfer to the intensive care unit. He has metastatic colon cancer. His blood has less than half of the normal amount of albumin (a protein that helps keep water in your blood vessels instead of leaking into your tissues). I gave him fluids. His blood pressure would go up for awhile but then the fluid would go into his tissues and his blood pressure would fall again. His legs were swollen up to his belly from all this fluid. The next step is giving medications to increase the blood pressure but this requires putting in special IV's and monitoring devices and an ICU. The labs were telling he that his body was not too happy with his current blood pressure. He was telling me that he was not too happy about going to the ICU. We waited. He hung in there. But I spent the night watching his numbers - his vital signs, his labs, his urine output.

Tonight I watched something else. I watched his family sitting around his bed. His wife and his daughter each holding a hand. The room was dark. There was gentle music playing in the background. I watched over the course of the night as we tried to get his pain under control, as he went from sitting in obvious agony to dozing off. I looked on as a man died. A husband. A father. I saw a room filled with love. And my heart broke. Bearing witness to a family saying good-bye for the last time.

There's no looking at numbers tonight. This is the part of medicine you aren't taught in books or lectures. It's the part that hurts. But it's also the heart of medicine. In between responding to pages and writing orders, I was reminded that I signed up to care for people when they are sick, hurting, and sometimes even dying. It's not a job. It's an incredible privilage to be a part of these moments.

And as the sun starts to rise today, Valentine's Day, I know I've just seen what true love looks like. It's not red and pink. It doesn't smell like roses or taste like chocolate. It's not bold or flashy. It's neither lustful nor selfish. It doesn't need. It just gives. It smells like home and tastes like tears. It feels like the warm sunshine. It's quiet. It's resilient. It's for keeps. Even after that last good-bye.

~ Joelle Rosser, MD, Post Graduate Year 1


I am so, so proud to have been on the other side of "send" after she honored her patient through that early morning email. What is being a great doctor about? Without question--love is the what.

Always, always, always.

****
Happy Valentine's Day.

The Monster in Me.

Funny thing about a garden

Beauty lives within its gates

Bugs and thorns and weeds they grow there

But they all help to create

Vivid color variations

Sweet aromas and sensations

Realize under it all

Something not so beautiful but we all

Need a little bit, I need a little bit

Need a little bit of dirt to grow

We need a little bit, I need a little bit

Need a little rain to wash our souls

We need a little bit, I need a little dirt to grow

~ from Mary Mary

____________

I pray over my children these words as they sleep:

"Lord, please protect them from monsters. Especially the monster in me."

The monster in me.

I am not a perfect mother by any stretch. Many of my meals would not be considered nutritious by anybody's food pyramid standards. I rush my kids more than I should and answer my phone to talk while I'm driving. I lose my patience with homework four out of five days and on some days I even want to cry a little bit. Partly because I have no idea how to do whatever it is my child has been asked to do but also because I just wish that, on this particular day, they could just do it without asking me.

Yes. I said it. Horrible right?

After work, I feel tired. Too tired for stuff like kids who want to be playful when they have a crap ton of homework and too tired to fight about taking showers. And it's not because I don't want to be playful with them. It's just that kids sometimes don't prioritize ninja battles over new math. It makes my head hurt when I think about it since I'm not fully convinced they should.

There are days that I kiss them from the living room and tell them to go hit the sack without any sort of tuck-in pomp or circumstance. I give in sometimes on things like letting my kid wear his Marshawn Lynch jersey three of the the five week days or I've decided that my other kid's propensity for never, ever wearing his Vans with socks (even in the dead of winter) is just too first world an issue for me to fight. We sprint like Flo Jo to the bus stop more often than we should. I fall asleep on my kids when they're reading to me and fall asleep while I'm reading to them.  A lot.

I sure do.

And some weeks are worse than others. Some weeks, yes, hot dogs are for dinner and breakfast is on the supper menu on another day. And as I'm serving it, I'm thinking, "June Cleaver would so not do this" or "I bet every other mom at my kids' schools are serving up some organic, gluten free gourmet feast right about now." I try to measure it out and say that prayer again, hoping it isn't too blasphemous to be crossing my fingers for added luck. When I'm speaking those prayers during my craziest weeks, I add on words like, "Please, please, please, let their minds hold tightly to the good things I do and their memories have amnesia to the bad things I do."

Am I too tough on them? Or not tough enough? Do I give them enough attention? Or not enough? Is it the right attention even? And. . .am I the bully I so vehemently warn them about with my exasperated digs during homework time? Am I? Hell if I know.

My point is just that life is such a swinging pendulum, you know? One day it peaks to the right as you being the world's most awesome mother and other days it sharply goes left and you (feel like you) suck. And I guess what I think about and pray about a lot is that line between what is just me being inside of my head and something real. Like really in the grand scheme of things will it be permanently damaging to hear me raise my voice over language arts or will it instead just be a blink on the radar? I honestly have no idea.

Many of us go by our upbringing. Mine is an N of 4--Will, Deanna, JoLai and myself. I remember a lot of things and mostly have very, very sweet memories of how my mom was with us day to day. I recall the period where she went back to college and the very basic meals that we had back then. My mom was no foodie when we were growing up and isn't now. But not having a meal that took her all day doesn't stand out. I recall scrambling eggs and eating cereal a lot, too. Yes, I remember it but more with warm nostalgia than anything else.

Those are the things I do remember. Either my mother rarely rushed us or I just don't recall it. With four children, I imagine that she had to crack the whip sometimes. I also have no recollection of homework being a challenge. Like ever. And maybe because it wasn't. But some piece of me deeply hopes that we did get rushed and that we did frustrate the heck out of our mom over our homework on a weekly basis. And that I'm simply amnestic to it all.

Sigh.

I am rambling, I know. And honest-to-goodness I'm just sorting out thoughts. I don't have the answers at all. But in this world of social media making people's lives and parenting looks so perfect, I am okay with saying, "Not this one over here." But am I trying at it? You're damn right I am.

Let me also say this: Nothing is wrong. I am not feeling sad today nor has some pivotal child issue rattled my cage. Not one bit. The kids are alright and the BHE is, too. I just like to unpack pieces of my life and then repack them again. I like reflecting and wondering and sorting through thoughts. And this is just one of the places where I do it.

So don't worry. Okay? Don't.

I just think that it's really deep to be a parent, man. And in my faith we believe that God entrusts us with our children. That idea is heavy, too, you know? Like think about the most precious things you own and who you'd trust to handle whatever that may be. So I also utter words of thankfulness for that piece of it and also petition to be equipped with whatever I need to get it right and not damage what's been loaned to me for a while.

Yeah. So my point is, as much as I fear some wretched piece of this big world robbing my children of their innocence or worse, their confidence. . . . deep down I believe that it's important to protect our kids from the worst, most broken parts of ourselves, too. That is, until they're old enough to understand those pieces of us.

In other words, sometimes we can be the big bad wolves or the monsters under the beds. And what's worse is, if we aren't careful, we're the ones that never go away.

That's all I've got, y'all. Thanks for listening.


_____

Life at times can make you weak
And I have cried myself to sleep
'Cause reality makes you cry
But the truth will dry your eyes

Things they just can't stay the same
When you work hard and you pray
Yeah, it may be kind of rough now
But the point I'm trying to make is that we

We all need a little bit, I need a little bit
Need a little bit of dirt to grow
We need a little bit, I need a little bit
Need a little rain to wash our souls
We need a little bit, I need a little dirt to grow

Oh, sometimes you may sing for yourself
You struggle hard just to prevail
It's the lesson you need to learn
It's the way you've got to earn

Champions never accept defeat
They fall and get back on their feet
'Cause they know like I know
That if you want to grow we

We all need a little bit, I need a little bit
Need a little bit of dirt to grow
We need a little bit, I need a little bit
Need a little rain to wash our souls
We need a little bit, I need a little dirt to grow. . . 


***
Happy Humpday.


Now playing on my mental iPod . . . this song encouraged me this morning after thinking about all of this. Maybe it will encourage someone else, too. Mary Mary singing "Dirt."

Joy lives here.

Man. I'm just glad to be here.

***

Happy Monday.

What kind of ISH is that?

Whenever I'm on wards, I find myself reflecting on my time as a resident. That was a pivotal time of becoming. And like one of my favorite quotes says, "Becoming is better than being." All day every day, it is.

Here's another story of just that. More will follow.

A little too black-ish

When people ask me where I'm from, I generally tell them that I'm from "the Los Angeles area." People that know nothing about the west coast pretty much leave it at that. But, as it turns out, a lot of people seem to know at least a little bit about Southern California. And so they gain clarity with questions like, "Where about in Los Angeles?" or, if they're super savvy, they'll try to throw a little shade at me by accusing me of being from those far away cities that are so far that they don't even count as Los Angelinos. Matter of fact, they even have a name for folks from those far-as-hell areas. I think they call it "the inland empire."

But I digress.

My point in saying all that was just to say that anyone who knows anything about L.A. gets it when I reveal just where in L.A. I was raised. I was raised in Inglewood. Yes, it's the suburbs. But no, it's not Kardashian-esque Calabasas or Superbad Santa Barbara. Nope. It was a place with predominantly underrepresented minorities and gangster graffiti on the sides of cinder block walls. But. For me, it was home and the place that had a hand in shaping me.

From there, I went to two historically black institutions of higher education in a row--Tuskegee and then Meharry. And in those places, I was a minority person by on the U.S. Census, but not in my life. My peers looked like me and so did my teachers. Black culture didn't have to get tucked under my shirt or packed on ice in the back of my freezer. It was the norm and simply the way of that world.

Yup.

I am not exaggerating when I tell you that I never really, truly felt what it was like to be "one of the only black people" for a sustained period of time until I started residency. I was the only African American in my class of residents, and there weren't a whole lot of faculty who looked like me either.

Nope.

People were super nice, though. Super nice. When I arrived in the hospital, it became quickly apparent to me that after all of those years as a minority in the majority, I didn't know how to assimilate. At all. The one week that I tried was so exhausting that I quickly told myself that I simply would not. Sure, I could speak standard English. And I'd been taught at Meharry how to be professional in my interactions. But what I couldn't do was behave in a way that wasn't me. I couldn't ignore things that connected me culturally to patients, colleagues, and  staff members. That just wasn't me. So I settled into something that felt right. Me being me and being cool with everyone else being everyone else.

Yup.

There was this guy who was one class ahead of me in residency. He was also black and had attended a historically black medical school just like I had. But that's pretty much where our similarities ended. He'd made a full time gig out of trying to be accepted through watering himself down. Black folks around the hospital got the virtual stiff arm from him.

When I first arrived, he'd taken it upon himself to look out for me. I can't say that I really wanted that from him since mostly it meant harsh whispers in the hallways about either what some fellow person of color was doing wrong or how each and every occurrence was a diabolical plot to take down the residents and medical students of African descent.

Uggh.

Mostly, I smiled politely while secretly ignoring him. That is until the day that I became his target.

"Hey Dr. Draper! Is this your admission? He needs orders." Sanika, the ward clerk on the hospital ward where I was working, tapped me on the shoulder while I was writing a note. I'd already been up all night admitting patients. I was scribbling down my final note when she said that. Sanika and I were always friendly and I liked her a lot. Our exchanges were usually relaxed and light. This day was no different.

"Naaaaaah, playa. I'm post call."

"Oh, my bad. You gon' do something fun?" she asked. She was patting the top and sides of her head with her hand when she said that. The blonde hair weave she wore seemed to be on it's last leg and, as every sister knows, the "weave pat" is something girls do when they don't want to mess up their weave tracks by scratching.

Duh.

"Who me? I'm probably I'm gonna fall asleep on my couch for a few hours. Then I'll wake up and go kick it with some of my friends later on." I cocked my head and chuckled as she continued tapping her head with her hand. "Dag. Is it that bad?"

"I'm getting this wig split!" Sanika laughed. "The whole shebang, girl. Cut, chemicals, all that!"

I knew right away what she meant. This was slang for going to the hair salon to get her hair done. "Do your thang, girl!" I said while giving her a high five. We both laughed out loud one last time and that was that.

A few moments later my pager went off. Cringing, I called back. I was super relieved to find that it was Albert, the guy in the class ahead of me and not a nurse on one of the floors.

"Do you have a minute?" he asked politely.

"Sure do.What's up."

"I'll just come to you,"

"Okay, Kool and the gang! I'm on the nurses station on 9B."

"Did you just say, 'Kool and the Gang?'"

"Ha ha ha . . .yup."

"Ummm. . . .okay. On that note, I'll see you in a minute."

I wasn't sure what he meant by that response, but soon I would.

A few moments later, Albert was sitting next to me with this really disappointed look on his face. He let out an exaggerated sigh as if whatever it was he had to say was going to hurt him more than it would me. Which made zero sense considering we just didn't have that kind of friendship. Like, at all.

He let out another enormously enormous sigh and this time he perched one of his elbows on a folded arm and rest his cheek in one hand. With his head cocked sideways, he squinted his eyes and finally spoke. "Kim? What's your deal?"

I'm sure I looked mad confused. Because I was. "Huh?"

"I'm just trying to figure out what your deal is. I mean. . .what is it you aspire to achieve in your residency?"

I was still lost. "Uhh. . . . get good training? Be a good doctor? Isn't that what we all want?"

When I said that part, he sighed again. I couldn't stand the way he looked at me. Like he was Mr. Miyagi but without the love and caring that went into the Karate Kid.

"You're kind of scaring me, Al. What is this about?"

"It's about the fact that you ain't in Kansas any more, Dorothy." He sort of curled his lips when he said that dropped his eyelids to half mast for emphasis.

"Say what?"

"You are a physician now. And you are no longer at Meharry. You can't be talking to Sanika about her weave appointments or kiki-ing at the nurses' station with her either."

"What the hell are you even talking about? Sanika is my buddy. What the hell is wrong with me talking to Sanika?"

"I didn't say don't talk to her. I'm saying you don't need to be all "honey chile" and "girl-fren" with her in earshot of other people. It's . . .it's just. . . "

"It's just what?"

"It sounds . . really. . .ignorant, Kim. And, well, n-word-ish."

When he said that--and let me be clear: He said the real n-word with "-ish" tacked on to it--I just sat there with my eyes widely gazing at him. I waiting for a beat to see if he would say he "juuuuuust kidding" but he didn't.

Nope.

And so. I just sort of sat there not knowing what to say. I was only a few months into my internship and the last thing I wanted to do was shoot myself in the foot from the very start. That pretty much was the end of the conversation. He'd cloaked me with a new insecurity that I hadn't quite felt before that moment. And it kind of sucked.

N-word-ish. He'd even tacked an 'r' onto the end of that n-word for emphasis. It was hard to shake. I walked around self conscious for the rest of that week. I second guessed all of my interactions with people in elevators, hallways and the cafeteria. My exchanges with Sanika were decidedly more vanilla. It wasn't a good feeling.

The following week, I was at one of my favorite classes in the gym one night after work. It was a step aerobics class and the instructor played lots of really upbeat music--a lot of which was popular urban music. Some old school song came on that I loved and to which I knew all the words. And you know? I did what I always  I started shaking my hips reciting the lyrics. Waving my hands in the air and laughing. Half of my friends in that class hadn't ever even heard that song before. But they seemed to dig it that I had heard it enough times to chant the lyrics without blinking. Like, dig it where it was fine and no big deal.

But work was different. Or was it?

Eventually I did the thing that I've always done in such situations. I called Poopdeck, my dad. Like always, I described all of the players involved. I painted a picture of Sanika with her unnatural blonde hair weave and dark brown skin, including the elaborate tattoo on her forearm with her son's name in cursive. Next I gave all the details about Albert. His preppy attire and dress pants with suspenders which he insisted we all refer to as "braces." The way he rolled his eyes when I walked up on the ward saying things like, "What you know good?" and using words like "chile."

"How are things going in terms of your job?" Poopdeck asked.

"What do you mean?"

"Your performance. What are the people that matter saying about you?"

I thought about that for a few moments. "Well. Actually, Dad, things are going well so far. I mean, I've gotten some really positive evaluations and feedback on my first rotations."

"That's good." Dad paused for a moment and then spoke again. "Do people seem uncomfortable with you being black?"

"With me being black? Uhh. . .if they do, they don't make it obvious."

"Let me be more clear. Does it seem to be an issue that you aren't ashamed of being black?"

That I'm not ashamed? Damn.

But you know? He was right. He was as right then as he is now. I'm not ashamed of who I am. I'm not. And you know what else? I don't like the idea of anyone else feeling ashamed of who they are either.

Nope.

So that's what we talked about. My father had been in corporate America for several years. Like me, he was okay with himself and proud of his heritage. But lucky for me, he'd navigated those waters long enough to know that sometimes it could be different for African Americans. And you know what? Succeeding seemed to come down to a couple of simple things, that is, according to what I gleaned from that discussion with my dad.

First, it comes down to being authentic about who you are and where you come from. But you have to do it while still leaving room for other people to feel invited to be authentic, too. If a person doesn't like who they are--that should be explored first. But if they do feel happy to be who God made them, that don't hide it divide it. Own it, man. And give others permission to own theirs, too.

It kind of reminds me of a funny thing one of my kids said several years ago:

"Yay ME doesn't mean booooo YOU." 

Yes. That. 

The other thing was pretty much the same thing he's told me over and over again for years. Be excellent. When you work hard and give your best, your differences might be received positively. He also explained that sometimes things just are totally unfair and that, without using these words, pretty much let me know that sometimes the haters are just gon' hate. The best panacea? Sustained excellence.

Yup.

And, of course, my dad also was really awesome about reminding me to appropriately walk the line between "doing me" and being unprofessional. That said, what that meant would be for me to determine.

That was a long time ago. I'm older now and have figured out that being true to myself requires a lot less memory and energy than trying to be what I think everyone else wants. I've also learned that your authenticity draws the same out of others.

Needless to say, I really frustrated Albert a whoooooole lot over the next few years. He pulled me up a few more times during my internship and hissed at me about being too black. It was interesting how worked up he would get over things that outwardly suggested blackness and how hard he'd worked to live true to the "less is more" mantra, but how much he complained behind close doors about "the man" trying to bring a brother down. It got really old after a while. Thank goodness he at least spared me that word "n-word-ish" that he'd used the first time.

That reminds me. Once I got some more time under my belt, I did things just to tick him off. I rolled my neck and talked about what I'd seen on BET the night before. Ha ha ha he hated it.

Anyways.

Here's what I know: When people don't like who they are or are harboring some self hatred, what they resent the most is someone else walking fully and boldly in the very aspect of themselves they despise. Black folks. Gay folks. All folks, man. And look--I'm not saying I have it all sorted out. But I do authorize myself to be who I am. And to not fall under some cloak of drone-like assimilation with whatever the majority is doing.

Yeah.

Albert was wrong. Not only was he wrong, he was disrespectful and hurtful. But now, instead of feeling mad at him, I feel sort of sorry for him. Some piece of me hopes that over these last few years he realized that what the world really wanted was the real him. And that him admitting to tasting chitlins or knowing the words to an old rap song. that is, if he really knew it, isn't "n-word-ish" at all.

Or any kind of -ish for that matter.

I say be who you are. Who you really are. And like my daddy said--what that means is for you to determine.

Yeah.

***
Happy Saturday. You know what? This ramble made me think of this--just in time for Black History Month.

Here is me last week after dropping off carpool. Some old Run DMC had just come on the radio and I STILL knew every single word. And you know what? I'm a girl from inner city L.A. who witnessed the birth of hip hop. Those words are in my head right along with the words to "Lift Ev'ry Voice and Sing." And you know what? Both are a part of me. And I ain't the least bit 'shamed. 

For Linda.

Let our hearts align in joy and pain

Let our eyes find fleeting solace when we pass in the hallways

Let our minds be willing to remember more than what they must

Or even believe that they must remember one another

Let our hands clap loudly for each triumph

Let our voices rise to the heavens for more than just our own sake

Let us all be aware, no matter how much it hurts . . . .

Since you are here and I am here, too

let us shoulder the sweet burden of love and life together

~ K.M. 

  2/4/2015

____________________________________

She said good bye to her sweet boy 25 years ago today. A truck struck his bicycle. And just like that, her only child was gone. He was only 13 years old. 

He loved to write and laugh and hug. He loved his mother and his life, too. His name was Damien. And her name is Linda. And she is his mother. 

Is.

I work with Linda. Not directly. But I pass her cubicle every single day in our faculty building on the way to my office and always say something like,"Good morning! How are you?" And usually she says, "Wonderful!" or "Great!" But today she didn't say that. Instead she told me that she wasn't good. Her eyes looked sad and they were glistening with tears. And then she explained why. 

Yeah.

I hugged her tight and cried with her right then and there. I told her how sorry I was and how badly I wish that she didn't have to live through this. And I meant that, too. 

Then I asked her to tell me some things about him. About Damien. And to show me his photo. Which is exactly what she did. That made us both smile.

When my life aligns with that of another person, I find myself wondering why. There are people we see each day who are going through all sorts of things. And no, we don't get every detail nor should we. But sometimes. . .I don't know. I'm realizing that I can open myself up to receive something as important as what Linda shared today.

Yeah.

 I'm asking you to keep Linda in your thoughts today. And if you are a pray-er, pray for her, too, okay? Thanks, y'all.

***

Happy Thursday.

Where better begins.

When I was a medical student and later, a resident, I had no idea how capable I was. I mean, I knew I was competent. Or at least, I had it in me to be competent. But most of the time I tip toed around hoping and praying that I wouldn't get the covers pulled back on the real me--the one who really wasn't so great at all.

I've talked about this before, this idea of thinking of yourself as an imposter. With each accolade, I felt the spotlight brighten. It was nauseating to think that people would look at me and point in my direction expecting some level of excellence that honestly, I was pretty sure wasn't a deliverable from my end. It was a sucky way to feel.

Yeah.

At some point I chose to start fighting against those insecure ideas. I coached myself to believe that I was who people thought I was or better yet, someone even greater if I could fight my fears long enough to explore what that meant.

I think of this every day. I ask myself, "Who are you? What are you doing with your spiritual gifts? Are you using them? Are you trying your best to transform a piece of this world?" The answers are mixed sometimes. But I strive to eventually attain very confident and firm answers some day.

I fight to help my learners see themselves as excellent. Some part of me wants to accelerate things for them and quickly push them away from self-deprecating thoughts as early as possible. To look them in the eyes and say, "You are more than even you realize. And I see it." I want to be sure that they know what I didn't know then.

Especially those who perform at high levels. For some reason, those are the ones that doubt themselves the most. And so. I'm specific when I give them feedback. It's more than just "strong work." It's, "Here is why I think you are awesome. Specifically, this is what you did that stood out." Then I observe and coach them, trying my best to dissect the liking them part from the here is why I think you are a highly competent individual part. Because sometimes that distinction gets blurry.

Yeah.

I guess my point of this ramble is this: I want to fight the imposter phenomenon with all of my might. I want those girls like me who come to majority schools to feel like they deserve to be there. I want those students who've had an academic hiccup to not think this is what defines them for the rest of their career. I guess I just want them to know what I didn't know. At least not fully.

I'm a lot closer to believing in myself than I used to be. One of my goals every day as a clinician and as an educator is to convince people, through my interactions with them, of who they are and what they can do. To me, that's half the battle. Better begins with belief.

Yeah, man. That's all I've got.

***
Happy Hump Day

The secret weapon.

The thing about residency is that your growth isn't just related to clinical acumen. A huge portion of it is dealing with people and their personalities. And you have to do all of that while learning to keep human beings alive. As I look back on it, that was one of the most challenging aspects. But you know? Some of my best lessons came from that aspect. Lumpy interactions that helped me learn how to navigate this high stakes job in the midst of not only my own crazy--but the crazy of a bunch of other people.

I've been reflecting on a few of my experiences--and how they helped me to grow. Here is one of them. More will follow.

The One-Upper

There was this woman I trained with who was really smart and highly competent. She had an answer for damn near everything and a lot of the times she was right. And all of that was cool.

But.

She also liked to be the person who'd been to the mountain top before everyone else. She seemed to take enormous pride in superseding whatever it is you saw on call or did on your rotation with some far more sexy experience that she'd already had to trump it. And you know? It was annoying. Annoying as hell.

I've always loved medicine since starting my training. I like to think about it, talk about it, revisit things and hash them out. I like to sort out aspects of a clinical story and try to piece them together. And back then with my learning trajectory going skyward, there was always much to debrief on. The highs, the lows, the wows and the OMGs. Mostly I'd do this with my friends, which this particular woman was not. But what many folks will tell you is that residency is kind of like boot camp. Ward teams are like the folks in the barracks with you and often out of necessity you share when your lives overlap for whatever time that is.

And so. One month in my second year of residency, I was placed on the same team as the One-Upper. And I will just give you a spoiler alert and tell you that it didn't end too well.

Ugggh.

We were in the Medical Intensive Care Unit that month. That's a place where the sickest of the sick come for care and the call nights have the most action. Well, the way our schedule was set up, our call days were like two days apart--that is the One-Upper and myself. So whenever I was post call and trying to sort out my patients and their problems, she loved to position herself next to the attending and fellow like she was my boss, too. She'd stand there with folded arms, feeling all super rested from being home the night before-- in contrast to my up-all-night hotmessness and scatterbrain to boot.

One night, I'd gotten this patient who was profoundly anemic for multiple reasons. Due to her hemodynamic instability, she'd been placed in an ICU step-down bed which, at our hospital, was managed by the ICU team. For us, step-down patients were like a breath of easy, fresh air. I figured I'd tank this patient up with the blood that she needed and would have her ready for transfer out of the unit in no time.

So check it--I'd given her a blood transfusion and, much to my horror, like two hours after she received it, she developed severe respiratory distress. Like severe, severe respiratory distress. This was not a woman with a ton of medical problems before hand either. It was terrifying.

Her respiratory status was so awful that she required intubation. And her blood pressure fell even lower than it had been before. And so. We supported her breathing with the ventilator and lots of oxygen and also pumped her with some fluids. Given the time frame of the symptoms, I decided that this might be something called TRALI--transfusion related acute lung injury.

Well.

I'd only read about TRALI. This was all academic as far as I was concerned, so I simply did the best I could given the circumstances. And fortunately, by the time the morning came, my patient had taken a turn for the better.

My attending studied the nursing notes and vitals for a moment as I presented the overnight events. "Wow. So that was pretty sudden. These MAPs (mean arterial pressures) are in the basement," he said.

"Yes, sir," I replied. "We started the pressors fairly early since we didn't have much reserve. She was already on the low side to begin with."

I saw the One-Upper shifting from side to side. I knew she was about to say something so I braced myself. "What about steroids?"

I just sort of looked at her and paused for a moment. "Um. Well, mostly what I read said you start out with supportive care."

She stopped talking to me and sort of shifted toward our attending. "I don't know, boss, what do you say? I've seen some good results out of these guys when you hit 'em with a little SoluMedrol."

Oh have you?

"Eeeeehhhh, you can." He studied the chart a little more. "Mostly it's all supportive but yeah, steroids are often given."

"I'm a fan of the steroids," the One-Upper chuckled. Then she turns to the medical student rounding with us and says, "So the patient has acute respiratory distress right after you've given a blood transfusion. We already talked about transfusion related acute lung injury. What else could this be?"

The student floundered a bit and threw out a few options. I felt my face getting hot. Partly because I was tired but secondly because I was tired and this woman was irking the heck out of me.

"Taco," she said with a smarty pants grin.

"Excuse me?" the student said. I could tell that student was wondering whether or not she was speaking of Tex-Mex for lunch.

"TACO," she repeated. "As in Transfusion Associated Cardiac Overload." She looked toward me and asked another question. "Dr. Draper, did you consider a touch of Lasix just in case?"

Let me be clear on something: The One-Upper woman was my PEER. We were at the same level and in the same residency class. And today, she was pissing me all the way off. While my attending allowed it.

"In case of what?" I responded flatly. I hated that she addressed me as "Dr. Draper" like that. A lot of attending physicians would do that. But fellow residents never used such formality unless they were standing in front of a patient.

"In case it's not TRALI and it's volume overload like TACO." I could have sworn that she twisted her neck when she said that part. I glanced to my attending hoping he'd get my cue for him to shut her up. But he kept studying all the overnight event recordings and didn't say anything. When he didn't, she launched into another spiel on TACO and how this could have been that and how it is actually indistinguishable from TRALI. She even sort of nodded to me when she said that as if I was also her medical student. She started to say more and I cut her off.

"She was hypotensive." My voice was flat. Irritated.

The One-Upper paused for a moment. Then went on, "Well, Kim, you've not actually seen both conditions clinically but I have and--" she turned back to the student--"they both present with respiratory distress so they're indistinguishable." Her tone was so condescending. I tried my best to be subtle as a took  drag of air through my nostrils.

"Hypotension," I repeated, this time with what I know was an attitude.

"Mmmmm. . . . .Well, actually the blood pressure in--"

I cut her right off. "They are distinguishable. One gives you really high blood pressure and one bottoms you out."

She squinted her eyes and tapped her lip with her index finger.  "I'm trying to remember what my last patient with TACO looked like blood pressure wise."

"Hypertensive," I shot back. Then I took a clear swipe which was immature, I know. "That's how she looked. And if she didn't, your diagnosis was wrong."

"Somebody sure is post call snarky!" the One-Upper replied with a snort. Then she turned back to our student and put a hand on her shoulder. "When you really see a patient with transfusion related respiratory distress, you'll be just trying to keep them alive in anyway you can."

My face was hot. Thank goodness for melanin because I know it would have been beet red otherwise. This had been going on all month and I had been up all night. I decided to clench my jaw and just shut up. Finally my attending decided to climb from under the chart and chime in.

"Well, that's true. . . but Kim is right about the blood pressure being the hinge that swings you from one diagnosis to the other. TACO occurs because of a massive upswing in the blood pressure." He yawned and swirled the tepid coffee he'd been nursing all morning and took a little sip of it. "Looks like things are  going in the right direction for this patient. Who do we have next?"

And that was it. That is for that patient, it was. That same thing happened four or five more times on rounds. And each time, my blood boiled just a little more. By the end of rounds I immediately walked off the ward to get away from her.

Yeah.

But everyone knows that when you really, really need to escape this kind of person they somehow keep popping up in your personal space. I was writing the last of my notes in the corner of the physician team room when the One-Upper came strutting in with the medical student behind her.

"Heard you ran two codes last night. Pretty busy," she opened up in my direction.

"Yuh." I kept myself busy, nose down in the chart and hand writing feverishly. My fuse was short and I knew I needed to get away from her before I lost it. I was also totally exhausted.

"I had a guy with a horrible pulmonary hemorrhage a few calls ago. Thank goodness I was able to position him to keep him stable until the Pulm team arrived."

"Yuh."

"Did both patients make it?"

I looked up and rested my eyes on her. I knew she knew that one had expired and one hadn't. But she asked anyway. I'd had enough.

I laid my pen down in an exaggerated slap. "Why are you asking me that? Like, why?"

"I was just wondering. Sheesh."

Her pseudo-innocence was making my head hurt. "No, you weren't. You heard me debrief with the fellow and you knew that one passed away and one didn't. So what I want to know is why are you asking me this?"

She put her hand on her chest and acted like she was surprised. "I-I-I I didn't know that--"

"YES. YOU. DID." I turned to medical student. "I'm sorry for this. I'm just really tired."

She awkwardly mumbled that it was okay and then excused herself, which was probably smart. Now it was just me and the One-Upper. Before she could speak,  I just shook my head and asked that she leave me alone. But she just couldn't respect that request.

"I just don't understand why you have to be so hostile. All I asked was a question."

I closed the chart and stood up. Against my better judgement, I spoke. "Did you just say hostile?"

"I mean, yeah. I asked one thing in small talk and you got all hostile."

"No. You didn't just ask a question. In fact, you never do. You just. . . " I wiped my face with my hand, sat back down, and sighed. "You know what? Just leave me alone. Please. Just go away."

She just stood there staring at me. Like someone had frozen her or something. "This has happened to me before in med school. People feel intimidated when someone smart comes along. Usually it's men who have the issue. But I guess this time it's a fellow sister."

"What?" I whipped my head over at her and crinkled up my face. That's when I knew I needed to remove myself. Which is exactly what I did.

Yup.

I called my dad and lamented to him about her. He listened and then said, "Why is she able to take over so easily when you have the floor? You need to think about that." That was pretty much the gist of what he said. I thought about it all night and throughout the following day.

That was enough inspire a new strategy. For the rest of the month, I spent at least one hour reading on every one of my call nights. I showered, changed into clean clothes instead of scrubs and arrived as ready as I could for rounds after those overnights. Instead of looking haggard and beat down, I coached myself to be the exact opposite. I countered her one-upmanship with excellence. And man was it an awesome weapon.

Yup.

What I learned from that experience was that it didn't even matter whether or not she was being an asshole. I'd given her space to step on my toes by not being excellent. In my head, I'd convinced myself that looking broken down would translate to how hard I'd worked and gain me some kind of badge of honor. But what it did was give someone room to usurp my presence as a competent clinician and teacher.

So I guess that's what I'm reflecting on. Excellence as a secret weapon. Instead of getting angry, I bleached and starched my white coat, shined my shoes, and prepared. I looked my attending in his eye, tried to anticipate his requests, and covered my bases. It was much more empowering than all that huffing and puffing I did before.

Yup.

Eventually, she stopped trying me on on rounds. The fun of it was gone. My buttons weren't pushable thanks to the perspective my dad had given me. And look---I have no idea what's going on with any of you in your lives or on your jobs. But let me just say this: When plotting your attack, consider just focusing on being more excellent. I can't say I always get it right, but trying at it makes a huge difference. Excellence is the pièce de résistance that shuts the haters down every time.

And even when it doesn't, trying to be excellent takes up so much energy that you won't even have time to care.

Yeah.

***
Happy Saturday.