"Just hold my hand for a little bit. And tell me I'm fierce."
~ my patient at Grady
You used to wear bow ties. That's what you told me. Flamboyant bow ties--real ones, of course. "None of that bullshit clip-on mess," you'd told me with a raspy laugh. I squinted one eye, twisted my mouth and did an inward chuckle. You saw my chest rise and shoulders shake even under the yellow contact isolation gown. Since you could see that I was amused, you egged me on by raising one eyebrow. This time my laugh was audible.
"I'll never see clip on bow ties the same ever again."
"So going to be judging them from here forward, right?"
"Totally." After that we shared a collective giggle.
The morning had been rather eventful for you. Biopsies and procedures invaded your young body, all necessary evils to getting all that is ailing you under control. And even though you'd been dealing with this for a few years, I could see beyond your cachectic frame and scary lab results. Your eyes never lost their boyish mischief. And when I explored, you let me right in.
"You know? I'm not like a lot of people," you told me one day. "Like, I've never been really afraid of my diagnosis of HIV. Hell, by the time I found out, it was already AIDS. But that isn't the part that bothered me. It's just the being sickly part."
"Being sick is tough." That's all I could think to say. So I looked at you with your long, sprawling eyelashes and waited to see what you'd say next.
"Being sick is tough. But being sickly is worse. I can get through little bursts of being sick. But being sickly has always been my worst nightmare. I have shit I want to do." I smiled when you said that because I sort of dug your transparency and smatterings of profanity for some reason. It made me feel like you felt comfortable enough to speak freely.
"I never thought of it that way."
"Yeah. I like being fierce. Suiting up and booting up. Walking through Lenox Place with a mohawk and a temple taper."
"In Lenox? Tell me more." I leaned my elbow on my knee and rested my chin in my hand.
"Bay-baaaaaay." You shook your head and laughed. "Honey I used to be killing it. America's Next Top Model didn't have shit on me. I'm talking European cut suits with short ankles and polka dot socks. And I would just do the damn thang."
"So you'd be at Lenox werking it, huh? WERK with a 'e', right?"
"Yaaaaaasssss, hunty! Yaaaaaassss!" You snapped your fingers from your bed. Both in the air at the same time. "Everythang on FLEEK."
That time I threw my head back and let out the biggest laugh yet. I'd learned of this slang term "on fleek" just recently in the hair salon. Though I had no idea why anything would be "on fleek" I did know that it meant that whatever it was was just right.
We talked a little more. Some about your hospital stay and management but more about you and your life. After about twenty minutes in your room, I knew it was time for me to get going. "I have to go finish making my rounds. Tell me, is there anything else I can do for you before I go?"
You stared at me for a beat and then sighed. "You know what? Yeah, there is."
"Tell me."
You reached your thin brown arm out toward my direction with your palm flat and open. Then you trained your eyes on mine, your beautiful brown eyes searing mine. "Hold my hand," you finally said.
Without even flinching, that is exactly what I did. I hated that a purple latex glove separated our hands from actually touching. But you didn't seem to mind. You spoke again. "Just hold my hand for a little bit. And tell me I'm fierce."
When you said that, I think you originally meant to be a little funny. But something about that made my eyes immediately sting and fill up with tears. Yet, still. I obliged you. I stared at you and imagined you as you would want me to see you. And I saw it. You in a real bow tie made with fancy paisleys all over it. A light blue seersucker suit with high water hems to show off your designer socks and wing tip shoes. Your signature mohawk fresh from the barber shop. And that mall lobby clearing out to become your own personal runway. I even saw Anna Wintour, Kanye West, and Gwyneth Paltrow applauding you behind oversized shades with cameras flashing all around. Yes. I saw it all.
I squeezed down on your hand hard. "Baby, you are more than fierce. You're on FLEEK."
A tear rolled down your cheek when I said that and softly you responded, an anemic and barely audible whisper. "Yaaaaasss, honey. Yaaassss."
After that I left your room. Then I went to the nearest bathroom I could find and cried and cried.
Today I rounded with my team and it was great. Things rocked and rolled along smoothly and everyone seemed to be in high spirits. We connected with our patients and embraced some teachable moments. And all of it was good. It was very, very good.
We were efficient. Like always, I looked at the clock and then together we decided upon an ETFR. That is, estimated time finishing rounding. Because everyone knows that, at Grady especially, there is always, always more to do and a reason to stay. Especially at Grady.
Yup.
Rounds finished up by 10:45 or so. The interns had work to do and loose ends to tie up. My resident was in clinic and the fourth year medical student had to scurry off to the senior resident conference. So that left me alone with Ben, the brand new junior medical student on my team.
Had we not just finished rounding this would have been a no brainer. I'd have grabbed Ben and hoofed it upstairs to the 12th floor and make "gravity rounds." That's when you start at the highest floor and see your patients based upon geographic location in the hospital. This only works if no one is critically ill on the service. In those cases, of course, the most ill get your attention first.
Anyways. What I did next is one of my favorite exercises that I do with medical students during such moments, so I thought I'd share.
Ben and I went to a quiet area near the nurses station. I handed him a piece of paper and said, "You're going to take a history from me, okay? My name is Mrs. . .uhh. . .Fanning. And I'm a 44 year old woman coming to the hospital for a fever and productive cough. You're going to take a complete history from me. Then I'm going to give you all of the elements of the physical and labs per your request. After that, I'll leave you for ten minutes. Then, when I come back, you're going to present her to me--including your assessment and plan. Okay?"
Ben's face lit up. "Okay!"
And so. Ben was introduced to Mrs. Fanning and her rusty sputum and shaking chills. He asked her questions about her present illness, personal life, and even how much she drinks. Honest Mrs. Fanning opened right up about her occasional marijuana, remote smoking history and her recent travels. She told him exactly where she was when she started feeling sick. ("At the corner of Moreland and Freedom Parkway.") Next, I reported the physical examination and provided him with her laboratory data. Ben copied it all down as I told him and asked a couple more questions.
And then? I stood up. "I'll be back in ten minutes, okay?" Ben nodded and immediately got to work.
I strolled around the nurses station and chatted up a few of my favorite nurses. I ran into Mario, one of my favorite people in environmental services. Before I knew it, ten minutes had come and gone. When I approached Ben, I found him feverishly writing down his final thoughts.
"Time's up." I offered him an exaggerated smile. "Let's make it happen." I waved my hand in my direction, summoning him to stand. "We are going to treat this like post call rounds. Sound good?"
"Sounds good!"
We stood in the hall way next to a random room. And Ben subsequently brought our hypothetical lady to life. He sure did.
"I think this mostly likely represents pneumonia."
I made him defend every management decision. Then I made suggestions on the areas where he felt less sure. The cool thing about this teaching exercise is that I get to not only pinpoint which areas of communication in the initial history to focus upon, I also get the chance to point out the things that normally no one says. How much you fidget with your hands. Your rhythmic "um" or your tendency to always say "actually" when you're word finding.
Yup.
So Ben was awesome and dear Mrs. Fanning seemed to be in good hands. But you know what was even cooler? Doing that little twenty minute exercise gives me confidence that the real Mrs. Fannings will benefit from my criticisms. And even better is that I got to have a foray into middle school drama again.
Yeah, man.
So this was what I did today at Grady. And you know what? It was awesome. I saw him growing right before my eyes. I just thought of something: I hated my Internal Medicine rotation because my attending ignored me and my resident scutted me all about. I was asked to introduce my self three separate times although I'd been there all month long. Like Ben, it was my very first clinical rotation. And you know what? I vowed to never do Medicine. Like ever.
But you know what? The buck stopped there with that. Ben didn't get ignored by his attending. Nope. I tried my best to give him my full attention. And his "patient" got his.
I guess today I felt like I made a difference. And when that happens, it is so affirming. Like I'm doing exactly what I'm supposed to be doing. . . .fanning the flames of enthusiasm so that a wildfire ignites in both my learner and myself. One that hopefully gets unleashed on all of their future learners . . . and especially on real Mrs. Fannings.
"She was up in age." "She had a full life." "At least it was peaceful."
I work in a hospital around sick people. As a result, I am near infirmary and death more than most people. A lot more.
I'm also 44 years old. Old enough to no longer have living grandparents without it seeming unusual. But in the grand scheme of grandparents and aging, we were fortunate. My last living grandparent, my maternal grandmother, passed away just shy of her 91st birthday.
Yep.
The combination of seeing people navigate death and dying--and also living long enough to experience it with the elders in my life--has taught me one thing if nothing else: There is never a convenient time to lose someone that you truly, deeply love.
Particularly a beloved parent.
Sure. When health fails and independence is robbed, some piece of you knows that transitioning would mean less suffering. Depending upon your beliefs, you envision lively celestial reunions with loves of lives and dear ones who left too soon. And all of that seems mostly reasonable in your mind. Problem is, the heart is always late to get the memo. The loss is filtered through love's myopic view, which blurs the present and sees far into the past.
My grandmother's funeral wasn't terribly sad. Kind words were spoken and afterwards when we all retreated to her home, those aforementioned words were spoken repetitively. And I guess, a little bit, they felt quasi-comforting to utter but the reality was that no matter how up in age she was, how full her life had been, or even how peaceful her passing, I'd never known a life without her in it.
I hadn't.
My grandma lived in Tuskegee, Alabama where we all went to college. My dear aunt took excellent care of her until the day she passed quietly in her sleep, and has since continued to live in the family home. This year, like always, I came over during my visit there for our college homecoming. When I walked inside, almost everything was the same. The same foods were on the counter, many of the same familiar faces and even the smell of my grandma's home hadn't left. The olfactory part was a comfort. But that was about it.
Immediately I had a strong urge to leave. My heart wasn't ready for that piece of my world to not include my grandmother and her high, tinkling laughter. Yes, my mind said those other things, but my heart was still far, far behind.
I knew my grandmother wouldn't live forever. But even when she passed, I realized that there is never a convenient time to begin a life without someone you deeply love in it. No matter how old or chronically ill. The finality of it feels suffocating in ways that can't be fully reconciled even with the strongest faith.
Someone special to me lost her mother today. She was up in age. She had a full life. And it was peaceful.
But regardless of all of that, somebody has lost her mother. And tonight, my heart is weeping for her and feeling sad. Because even though it may have been time, I know for certain that the time never seems to be right.
First day of the hospital rotations for Small Group Delta. I pressed them to send me a "selfie" photo to capture this day. "You'll be glad you did," I said. And I meant that.
Time flies. Especially when you are watching from the seat I'm in. If you don't slow down, you'll miss it. Or maybe forget some parts that you should have savored.
We met up tonight for a debriefing of day one over tacos, ceviche, salsa and chips. And all of it was good and all of it was warm. Just like a family dinner table. They shared about their winter breaks and recent travels. Jessie, my advisee who is taking a detour to work on a PhD, enlightened us on her new life as a PhD candidate. And you know? That part was really great, too.
I'm going to blink and they'll be graduating. This I know for sure. But I will blink as slowly as I can.
As slowly as I can.
I love this aspect of our curriculum design. And tonight, once again, I was reminded that I love every single one of these people, too. They are a part of my family.
How cool is it to have family ties built into your medical school requirements? I'll answer that.
"We write for the record, for sanity, to see ourselves whole."
~ Angella
A learner that I've worked with sent me some of her writing to read. She'd written a piece that she's considering having published and wanted my opinion. Her writing and her story was lovely. This morning I shared some observations and feedback. I was as honest as possible and let her know that I felt like she was holding something back. She then told me that much of what I was pushing her to do was the stuff that she'd typed and then deleted. And then typed again and deleted again.
"Why?" I asked.
"I don't know," she replied. "Scared, maybe?"
"I'm always a little scared," I responded.
"Really?"
"Yep. But to me? Our best writing is brave. Be brave."
That's what I said. And she got it. But then I stuck it on a post-it note in my head for myself because I needed that advice, too.
Yeah.
On a lot of days, I don't know what brave even is. But I guess I'll say it means. . . authenticity within reason, you know? And the "within reason" part is for the individual to define.
A writer whom I deeply, deeply respect said this to me today:
"We write for the record, for sanity, to see ourselves whole."
And this? This is everything. It is the bottom line of it all. I love these words because I read it as "we" meaning those who write but the "ourselves" being this entire world and every soul in it. I want to see ourselves whole. All of us. Writing helps with that.
Yes.
On another note, I guess you probably looked at that snapshot and wondered what that was all about. I took this photograph of myself in November of 2012 just a few days after Deanna passed away. It was in the middle of the night and I was feverishly writing, writing, writing for sanity, to counter the pain and to push through the heavy metal door of this new normal without my beloved sissy in it. And much like the things I wrote back then, though complicated and perhaps too transparent for some, I feel glad to have turned a camera on myself that night. This image serves as a piece of that record. An important record. And it captures a time that I want to remember and allow myself to feel sometimes.
I never posted this photo here or anywhere before today. I guess I wasn't brave enough. But today, that's how I'm feeling. Brave. LIke a lion of sorts.
It's weird. Though I never shared it, I've studied this photograph what feels like a million times. Each time, I see something new in it. Some days, all I see is my middle-of-the-night tired and droopy eyelid. Other days, I see more. I see myself trying to reconcile Deanna's death with my faith. I see sorrow on some days, anger on others. But especially, there is something that I always, always see. I see love. Unapologetic love. For the record.
That gives me great comfort. It may sound weird, but it does.
I will show this picture to my grandchildren someday. Or at least I hope someone will. And I will let them study it, too--for the record. They can see how much I loved my sister, Deanna, their auntie, of whom they are descendants. And I hope my boys will grow into men and read the words I wrote during that time. I do. Words that will bridge their fuzzy childhood memories to the adult account of their mother during the same time. And give them a full picture of how love lives on and on and on. I also hope that even if my mind starts to run away from me as I grow older that images like this and the words that accompany them will anchor me, serving as my registry, my testimony, and a reminder of the many pieces of this dream I live each day.
Yeah. That's what I hope.
So yes. We write for the record, for sanity, to see ourselves whole.
Yes. That.
That is all.
***
Happy Tuesday.
Now playing on my mental iPod. . . Sara Bareilles singing what I often feel is the soundtrack of my bravest writing. Her question, "I wonder what would happen if you say what you want to say and let the words fall out? Honestly, I want to see you be brave." Me, too.
You know what? Blogging is work. I mean, it's work, like. . .in a good way. But still. It requires a level of commitment that is tough sometimes.
My blog has become a good friend. A loyal one, too, that patiently waits for me to finish my thoughts and complete my sentences. She doesn't limit me to certain word counts nor does it offend her when I drop the occasional F-bomb.
Nope.
But again. Like any really meaningful relationship, it calls for some sacrifice. And that's hard when other parts of your life call for it, too.
Over the last six months or so, my life got even busier than it had been before. I began tinkering with writing a book along with a lot of other stuff in my professional and personal lives that have called for more of my time. So I'd start blog posts and leave them sitting like half eaten sandwiches in elementary school lunch boxes. Perfectly good to eat but, after a while, overshadowed by something else on the menu.
Yup.
Per the stats, the readership went down. Significantly from what the counters showed me and, at first, I felt guilty about it. I would worry that I needed to write something but would argue with myself that I'd promised never to fold this into the list of life's burdensome demands. So yeah. With larger spaces between posts, the numbers crept down more. And here lately I'm realizing that ,for the most part, it has to be cool. Not cool as in "I don't care" but cool because it's just the way of this kind of world and a nice little reminder that writing has to come from a genuine, courageous and honest place. Not one that's forced or that clamors for comments or hits on a post.
Wait. I take that back. For those who blog for a living, they should consider that. But since I don't, I suppose it's good for grounding me a bit, you know? And as I think of it, that probably happens to a lot of bloggers who've been at this longer than me. And so. I've been pondering all of that. And I feel myself plugging back in to the reason I first felt so hungry to write here in the first place.
The other day I refreshed my stats and comments page before going to bed and saw a sagging three-digit number of hits for a twenty four hour period. And zero comments. Then I thought of some of my favorite blogs over the years and how they started to dwindle at some point. I checked in several times in a row and saw no activity and eventually just stopped checking. Just maybe, they exist somewhere again but since I no longer look, I don't know it.
Yeah.
I also recall how much time I've spent savoring the delicious words of so many of my fellow bloggers and how they'd become real, true friends, albeit virtual ones. On a lot of the days where I just can't finish out my whole thoughts into my own blog, I silently savor theirs. But when life gets really busy, even that is hard. So I lose my grasp on that part of the "blog world" as well.
Yep.
I guess I'm just rambling about this because blogging is such an interesting reality. It's communal yet lonely at the same time. It's like talking to a bunch of friends and babbling in a corner by yourself simultaneously. Which evokes an equally pendulous set of emotions if you engage in it. I do think it's much realer than a lot of other forms of social media and, though more time consuming, a lot more rewarding.
For me, at least. On most days, that is.
So despite the complexities, I am feeling very grateful tonight. To this platform and to any person who has even read here a single time. Because all of it--the collective--has saved my life over and over and over again. It has helped me to remove many masks and pull the covers back on the me that hides from even myself. It has given me solace during my darkest days and a midnight canvas for bursting fireworks in vivid colors with each triumph. I've found refuge here when insecure, bored, afraid, confused, and conflicted. And on those days that started out with me flying on one gimpy wing, I turned to this, the written word, and found myself lifted high into the clouds on a brand new pair.
And soar, I do.
And so. Today I regroup. I return to my blog as a steadfast friend. . . just as I have since 2009. The one who forgives my imperfections and inconsistency. The one who was easy to fall in love with because of her paucity of rules and regulations and her gentle nudges to live a life filled with more intention and authenticity.
So I will write. No matter what. When I can. How I can. So I can.
I remember logging into the protected residency website that houses all of the call schedules a few years back. Waiting for the page to open has always felt like spinning a wheel on Wheel of Fortune--nearly every possible wedge upon which the wheel can land is mostly good with only the very rare BANKRUPT tab. That said, even rarer is the $5000 mark that happens about as frequently as a lunar eclipse. The resident and intern assignment odds are fortunately better than game show ones. The chances of hitting it big are much greater and, even better, the BANKRUPT tab is nearly nonexistent.
(reference photo for folks to young to get the reference.)
Yup.
So this particular month, Vanna White was on my side. I scanned the list and did the slow Tiger Woods fist pump.
No, seriously. Almost exactly like this:
Yes. I'd hit it BIG on the scheduling game show this time. Matter of fact, this was right up there with somebody yelling out, "A NEW CAR!"
Oh yeah, baby.
Interns: solid. Medical students: Not familiar with them but likely solid, too. But the Tiger Woods celebratory gesture? Oh that was for the person designated to lighten my load--the resident assigned as my right hand woman. The scheduling gods blessed me with a RISING CHIEF RESIDENT. Did you get that? Let me explain. See, this senior resident assigned to me had already been asked to be a chiefresident--which in a land of smart people is a big deal. So suffice it to say, she was as smart as five whips cracking all at the same time on the same behind. Now that? That's smart, baby.
Mmm hmmm.
So yeah. I did the happy dance and bragged to a few of my colleagues when queried about my resident for the coming month. It was the summer time and let me tell you--the living was about to be easy. For me, at least.
Now. Sure, I went through those fleeting thoughts of terror with regard to working with someone so smart and highly competent. And yeah, I shuddered a few times imagining some clinical curve ball being hit directly to me and, instead of knocking it out of the park, completely striking out. . . only to have the uber-genius future chief resident come right behind me and smash a grand slam into the rafters. Off of the same pitch.
Yeah. I thought those things but honestly, this resident was not only smart and a future chief resident--she was someone that I knew fairly well already. We'd had a good working relationship from the clinic so I knew that this would be a piece of cake.
Oh yeah, baby.
Now. Let me just discuss for a bit on just WHY I was so happy about this assignment. The truth is that it wasn't just about the fact that she was bright and pleasant and considered one of our best. If I am honest--and I try hard to be on this blog--it was more an opportunity to put my brain on ice for a little while. No--not from the patient care standpoint so much. More from the stressors of looking over my shoulder and under every little nook and cranny for something wrong.
And.
No sort of remediation would be needed. What. So. Ever. Hallelujah, man.
And so. I was going to show up with a plan to simply let this superstar resident do her thing. Because the word was not only out on her level of competence--I'd seen it first hand. Moreover, she was in her final year of residency so what was the point of me coming up with some sort of hair brained scheme to transform her in any kind of way?
And this? This is what I am reflecting on today. This thing that I have discovered that happens with a lot of high performing individuals after a while. This point where, instead of us pushing hard and finding ways to help them excel in new ways, we simply shut off all of our faculties and put it all into cruise control. And you know what? Even though it doesn't feel that way, it's like giving up.
Yeah. I said it. Giving up.
It's so pervasive, too. Even though it doesn't create a mutiny and even though for the most part the learners themselves don't even know it's happening--it is. A lot. Even with the really, really great educators it is.
It is.
Sure, at the beginning we push them and applaud their every milestone but there is this threshold that gets crossed where, as I mentioned before, the word is out. He or she is uber-exceptional and has already been given some sort of metaphorical gold star to prove it. So what do we do? We throw our hands behind our heads, lean back in our chairs, and snooze for a little while.
And okay, okay. If you don't like me saying "we" I will just go ahead and raise my own hand and say "me." Because not only have I been guilty of it, now that I am thinking about it and dissecting this idea, I recognize it as something that happened to me at several different points in my training and beyond.
Let me explain.
Usually it starts with some person planting a seed about just WHO this person you're working with is and just how awesome-great-amazing-the best-superstarish-thebombdotcom that they are. And sometimes you've seen it for yourself but a lot of times, you haven't. You just roll with it. Then the person shows up and what you see is through that lens. Which is mostly fine. And often accurate.
But.
What happens next is the thing that since that month with Tiffany (the rising chief resident assigned to me that year) that I've been trying to fight. It's a sort of inertia. I like to call it "high achiever inertia." This point where everyone sort of gives up on trying to do anything special to bring out an even better version of the person who everyone is telling you is already the best.
Did that even make sense? Stay with me. I'm going somewhere,
So check it. Usually there are heaps and heaps of flattery involved. From the start whether warranted or not, the person is lauded as fantastic and a star before they've even done one thing. As time marches on, the sweet words prove to be as empty as sweet foods--delicious to hear but of no real nutritional value. Feedback sessions morph into these nondescript proclamations of excellence without examples. And the person on the receiving in--who is human--eats it all up without even realizing that it was not a balanced meal at all. Or worse--that for the last several months, they've been fed the same, exact plate of food.
Yup.
I know how this feels. I lived through the "hey, you're going to be chief resident!" announcement and experienced the stealthy downshift in meaningful nudging toward new potentials that came from those who worked with me. And I didn't even know it was happening for the most part. I didn't.
Then, during my chief year, my Internal Medicine chairman, Dr. Blinkhorn, started having these weekly meetings with me. He'd give me specific feedback on my teaching and would ask me provocative questions about how I was running my ward teams. He wanted to know about the feedback I gave to learners, what I did at the bedside, and more. The points I made on the chalkboard--though often salient--he challenged. Questions like, "Who are your learners?" and "Do you think that was as effective as it could have been?" were common. He'd even say to me, "You look exhilarated. I can tell that session felt good and like you were in the zone up there today. Let's talk about why."
And that? That was awesome. Just freaking awesome.
Two or three days into working with Tiffany, things were going fine. It was as I had anticipated: She was exceptional in a myriad of ways and I was enjoying the welcomed diastole that came with along with it. But then something happened with a patient. Nothing wrong at all. Just a situation where I watched this excellent resident physician navigate one aspect of patient care into which my personal experience afforded me insight. And so. I took a moment to chat with her about it.
Yep.
Something about that conversation triggered an onslaught of memories. Specifically, I was transported back to those Tuesdays with Blinkhorn and just how pivotal they'd been for me. I put that on a post-it note in my head and vowed to come back to it later that day.
And I did.
That lead to a gigantic ah hah moment. Dr. Blinkhorn did something that very few people had done for me. He fought against the downhill momentum of "high achiever inertia." This was more than someone choosing to push a learner from good to great. This was something that was, in my opinion, even more profound. He approached his chief residents--the ones he'd personally selected--as if he could move them from what many perceived as great to even greater. And instilled in me this idea that we are never ever there. The destination is always moving higher and higher, forcing us all into a zone of development that we deserve.
Yes. That. This zone of development--not some high achiever comfort zone where everything morphs into the predictable and straightforward and hence the default of flattery takes the place of real, true strategy. That.
So that got my wheels turning. And so. I asked myself:
What if. . . like. . . what if I actually set out to do something transformative with this learner? This one. This known-to-be-already-excellent learner? What if, in spite of everyone saying "oh me, oh my, your resident is awesome". . . what if I actually had the audacity to think that I could still do something to push her deeper into the zone of development? What if? What would that even look like? What would that even feel like? And. . . what would that take? What would that mean to a learner like Tiffany who, by everyone's standards, is at the top of the pack for her current level? Hell, what would it mean to me?
Well. I'll tell you. It would mean planning on my part. It would involve thinking and preparing in ways that I hadn't before. It would call for a boldness and a confidence that I'd not yet fully challenged myself with and a trust in my own ability to actually do something meaningful with someone like her. That was uncharted territory for me. So was I insecure about it? You bet I was.
Let me tell you what happened. It was transformative indeed. But not just for Tiffany. It pushed me into a zone of development and called for something more from me. I tapped into creativity and honesty that had previously lay dormant in such situations and the outcome? Man. It was awesome.
Yeah.
So I guess that's what I've been thinking about. How to not give up on the high achievers or the proficient performers. And you know? This isn't just in the work place, either. This can be applied in other aspects of life, too. Kind of like the way your child who calls for more academic or personal attention from you somehow seems to get all of it, while (hallelujah) the other one just plugs away independently. In between moments with the needier one, you do what just might be the minimum--checking always finished and correct homework, giving high fives, and feeling grateful as all get out. Which is fine sometimes but when sustained is really no different that that same idea of coasting along in the cruise control of high achiever inertia.
Or in this case, easy kid inertia.
Whoops. My bad. If your toes hurt from that last part, just know that the person who stepped on them has just had hers crushed as well.
Ummm yeah.
But I digress. So let me get back to a professional context before some toes get amputated.
I guess the thing is. . . . .these guys will usually be fine, you know? These high achievers--they will. And some piece of you knows it which is why we don't fully freak out about or even think about this--as the giver-upper or the giver-uppee. But imagine--just imagine--what it would be like if they, too, got the level of thought and preparation as everyone? Or better yet, more than just back slaps and applause to fuel their independent development?
I think those greats would be even greater. And, even better, they'd pay it forward first chance they got. You'd better believe they would. At some point, at least.
When Tiffany finished her chief residency, during her parting words she said one of the kindest, most memorable and most encouraging things I've ever heard any learner or colleague say about me to date. And, at the risk of sounding self important, I will share it--not because I need to puff out my chest--but more because what she said serves as a tangible affirmation of something I was really trying to do. As lofty as it sounds, I was trying to be transformative. I should also note that Tiffany was known for being stoic which made her words just that much more meaningful.
She said:
"No attending had more influence on me during my training than her. Doing a month on wards with Kim Manning as your attending should be a required part of our curriculum for all residents."
Yes. That is what this high achiever who'd already been asked to be chief resident, who'd arrived on my team as "one of those residents that everyone knows is awesome," and who just maybe knew more medical facts than me said in my earshot to a roomful of people.
Uhhh, yeah.
This simple statement will always be high on the list of the proudest moments of my career to date. Because I knew how hard I'd tried. And you know what else? It moved me so greatly that I quickly typed it nearly verbatim into my the my phone for posterity.
Okay maybe posterity is a strong word. But I at least wanted to have those words to revisit and unpack for later.
Sigh.
Here's the thing: No award was given with it. And nope, no plaque, publication, or confetti either. But that? What she said that day? Man. That's what I hear in my head on my shittiest days. It's what pumps me up when I feel myself giving up or falling into a lazy pattern that isn't unique to THAT learner.
Is it exhausting? Hell yes. But the reward is insurmountable. And freaking awesome.
Look. I can't say that every strong learner that I've encountered before Tiffany W. got some watered down, lazy educational experience from me. But I think the difference is that the level of intention I have when working with those performing at that level changed. And thanks to her, I actually believed I could make a difference. Even with the less junior trainees, I started to believe I could.
Yep.
So that's what happened. And that's what I challenge myself to do every single chance I get. For the known superstars, yes. But also for the ones who are superstars in disguise.
Which reminds me: I wish I had time to talk to y'all about how a lot of superstars get mistaken for average.
Mmmm hmmmm.
But that's another subject from another post. Oh. It's in this one, actually.
Ha.
Okay. This has been long enough so let me just wrap it up with this final thought:
If you keep trying at this and being intentional about what you do with every single learner, after a while perhaps a different word will get out. Yeah, man. Not that you're just nice or competent or full of random facts. Maybe an expectation will get handed around that this person--you--just might be bold enough to try to transform those working with you. Even if they're not a problem child or someone super junior or someone who's been dubbed "just okay." Yes. Even if that person is known to be a star, the rumor might be that you'll still try to make them shine even brighter or in ways they hadn't before. So then no one will show up expecting an experience with you to be super-comfy and vanilla.
Nope.
They'll arrive with a nervous disposition expecting to be a little uncomfortable. Not too uncomfortable. Just kind of. I mean, maybe this could happen, you know? This could be the new word on the street when it comes to you. Even amongst the superstars.
with Tiffany at her Chief Resident farewell program
Then guess what? YOU'LL get forced into a zone of development right along with them. . . . . .the same one that we're all hungry to inhabit but that we don't realize we craved until we're there.
Yeah.
Jen S. and Lucas G. -- two that challenge me constantly. And I love it.
****
Okay. Here's the challenge for everyone reading this who works with someone excellent: Don't give up on them. Don't just float on your back in the pool basking in the sunshine without moving. Because when that happens on your watch, they stagnate. And when they stagnate you do, too. But guess what? When you push them into the zone of development, you go there, too.
Every. Single. Time.
*Based on Vygotsky's Zone of Proximal development--a concept that I like.
***
Happy Sunday.
Whew. That was a lot. I know. And maybe it made zero sense to you. And maybe it set off alarms for you instead. But either way, I appreciate you letting me unpack, okay? I really do. Keep on moving, y'all.
Now playing on my mental iPod. . . . a song that blasted in my dorm room many a day and many a night circa 1990. Soul II Soul singing "Keep on movin'."
"Due to inclement weather, your kids' school will be closed for the second day in a row."
Maaaaan, I'm calling the automated message line back and leaving a message that says, "Due to the fact that I am very impatient and also have a whole bunch of stuff to do, I'm bringing my kids up there whether y'all like it or not."
Snow-day, shmoe-day.
Something tells me that this wouldn't go over so well. Ha.
Feeling sort of random so if you have anything remotely important to do, please stop reading here. I'm serious. This will do nothing to enhance your brain. But then again, sometimes things like that are welcomed aren't they? Yes indeed.
So let's see. Where to start? Oh, this:
Why is it that I am so, so annoyed with The Duggars family -- you know, the ones with the 19 children -- but paradoxically intrigued by the happenings of their family when shared in People magazine? So now the little Duggars are having babies and getting married. On the cover of my very important literature (People) is the one who just got married and the whole story is about her and her new husband.
Mmmm hmmm.
Yeah, so they didn't even kiss before they got married. And when they did kiss, they went and did it in private. So yeah, that was interesting. Man. That's kind of impressive to hold out on kissing. Being a bad kisser is SUCH a deal breaker, man. I'm glad it worked out for them. Or that it at least appears to be.
What next? Got to see one of my favorite former students a few weeks ago. It was so awesome. It never gets old to me when folks come back to town and call me to meet up. Kevin will always be one of my absolute favorites. He made me a better teacher and physician for sure.
Ha ha ha . . . I posted this on Facebook. . . this super romantic looking picture of the BHE and me from Valentine's day.
Followed by this next snap of our kids who were ON OUR DATE with us.
Funny how romantically perfect social media can make things and people look, right?
Yawn. What else? Oh yeah. Speaking of people not even being perfect. . . I got what I deserved yesterday. Have I told you guys about my tendency to silently judge peoples' grocery baskets? OMG. I do it. I try to keep my face all straight as they put stuff on the belt but deep inside I'm all like, "GIRRRRRRL!!! CUP O'NOODLES???" or "Do you have any idea how fattening prime rib is? Sir? Do you?"
Especially if they're in work out clothes. Which for some reason they usually are.
Now. This is completely independent of my own Cap'n Crunch, Hebrew National hot dogs, Eggo waffles and lemonade. I told you already--I judge THEIR baskets. There are perfectly good excuses for every bit of high fructose corn syrup and refined sugar in MY basket.
Mmmm hmmm.
So yeah. Yesterday I'm standing in line behind this lady who had on, of course, work out gear. Now me, I'm getting fake snow day staples like bread, milk and Reddi Whip whip cream. This woman starts pulling all kinds of stuff out of her buggy. Extra buttery microwave popcorn, Oreo double stuff cookies, fish sticks, a thousand different frozen meals, some Digiorno's pizza, a Graeter's ice cream, and like three or four packages of Jimmy Dean sausage biscuits.
Mmmm hmmm.
So I squint my eyes and try not to give a "chile please" smirk. And I secretly think she caught me doing the side eye so I tried to look all happy and sweet which, I think, worked for like two minutes.
Mmmm hmmm.
So she pays for her stuff and keeps it pushing. And I start checking out while watching her leave thinking, "That microwave popcorn is the devil." That is the devil in who will make you not be able to fit your Prada.
Mmmm hmmm.
So the person behind me starts putting their stuff up there. And this person was all UBER granola. Like every single thing was terrifyingly organic. Oh, did I tell you? My buggy judgement is on both sides of the pendulum. I hate on the unhealthy shoppers and equally hate on the super-duper healthy ones. Ha ha ha.
So yeah. This couple had a little kid in the front seat and she looked to be about four or five. And I am just looking and thinking, "That poor child. She is thinking, 'Can a kid just get a bag of damn Cheetos up in here?'" And OMG they even had some of those fake meat hot dogs and burgers.
Ick.
So yeah. In the midst of me sizing up everybody in Kroger and their pantry selections, the time comes for me to pay.
"Debit or credit?" the kind lady asks me.
"Either is fine!" I chirp back.
But then I discover that my wallet is in my other purse. And that I have no cash.
Mmm hmmmm.
So guess who had to be THAT CHICK who pushes her buggy to the side and vehemently apologizes? Uhhh, that would be me. And when I said, "Can you leave this right here while I run home to get my wallet?" I am 100% that little girl in the cart behind me curled her lips and gave me this expression.
Which was really what I sort of deserved.
Sort of, not fully.
Hmmmph. That's why all she gets for snacks is celery and she doesn't know what a Pop Tart even IS. See? Aren't I mature?
Heh.
What else? Oh. I remembered more slang when I was in the hair salon yesterday. The first is this: "In a bad way." This is when somebody wants to do something but it isn't going to work out. The person who says this is usually making it clear that they can't help nor will they with whatever said situation is.
Ha.
For example. Just yesterday while my hairstylist was on the phone speaking with a client who was talking so loud that I could hear everything from the chair:
"Sakinah! I got stuck at work. Can I still come?"
"Oh, boo, I'm getting ready to go after Kim. You were supposed to be here two hours ago."
"I know! Please, please, please!"
"You in a bad way. I can take you Friday but not today."
And that was that.
Here's another: "You tripped."
That means you made the wrong decision and now you are regretting it. Or someone else made a bad decision and you are talking about them making the wrong decision. Ha ha ha.
"Jessica Simpson blew up after she got divorced from Nick Lachey. Her shoe and clothing business makes millions, man."
"Yeah. He tripped."
Whoops. That reminds me. "Blew up" does not refer to her weight. It refers to somebody succeeding financially or professionally.
"Girl, I start my new job next week. I'm 'bout to blow up."
"That's what's up, girl!"
Ha ha ha. Did y'all know those?
Here's one more which is so ridiculous but a regular piece of the vernacular: "Smelling yourself."
This describes when a person gets cocky either because they've grown a bit older or maybe that they've recently blown up. Ha. Maybe it has to do with hormones? Hmmm. Hell if I know. Here's an example.
"My son has lost his mind. He had the nerve to talk back to me last night."
"Really girl? What's that about?"
"I guess since he's a senior in high school he's smelling himself or something. I sure took those car keys though."
"Ha ha ha, he tripped!"
"Yeah and when he started looking all sad since he had a date planned I told him, 'Bruh, you in a bad way. You should've thought about that before you started talking crazy.'"
*High five*
Ha ha.
That reminds me. I may or may not have schlepped my children with me to the hair salon on fake snow day #1. And there may or may not have been at least three other children there with their moms on their fake snow days, too.
Mmmm hmmmm.
Ummm let's see. What else? Have you guys ever tried flavored balsamic vinegars and olive oils? I'm obsessed with them right now. So delicious. And low in sugar. The oils make your whole house smell amazing. Just ran out of my garlic flavored olive oil from Atlanta Olive Oil Company.
Must. Get. More.
Speaking of which: My grandmother on my mom's side once told me that if I wanted to be a good wife and have my husband come home to delicious smells in the home here's the trick: Just sauté some onions in a little oil. No matter what leftovers you're serving, the house smells like you are wife of the year. Hand over heart she told me that.
"So you just sauté onions no matter what you're cooking?"
"Yep. Especially when it's just leftovers."
"What if he sees the onions?"
"Oh, you put those up. Or dump them in the leftovers."
Yes. This was what my grandma told me and quietly, it is genius advice. That woman had a college degree in Home Economics and knew all the tricks of the trade. She was also married for longer than I've been alive.
So get you some onions at your local Kroger when you go. And some Reddi Whip.
Ha.
OH and last but not least. SPEAKING OF KROGER. . . Y'all. Y'ALL!!! Did you know that in Atlanta they name all the in-town Kroger stores with nicknames? OMG. So funny. Okay, so check it. I'm talking to one of my residents who is trying to tell me where he was the day before on his off day. And as he is describing the restaurant he then says, "You know, right by Murder Kroger."
And me, I'm like WHAAAAT???
So it turns out that everyone knew this but me. Soooo. . .there's Murder Kroger in Fourth Ward/Downtown, Disco Kroger in Buckhead, Kosher Kroger in Toco Hills, Baby Kroger in Downtown Decatur and Hipster Kroger in East Atlanta. How funny is that?
Yep.
Yawn. I think that's all I've got for today. That and just a little more Stefon who is, in my opinion, SNL's funniest characters of all time.
Okay. That's it really. Thanks for wasting good time with me.
***
Happy Fake Snow Day to all. I hope you don't get hit by a fake snowball.
Honestly? I write this blog to share the human aspects of medicine + teaching + work/life balance with others and myself -- and to honor the public hospital and her patients--but never at the expense of patient privacy or dignity.
Thanks for stopping by! :)
"One writes out of one thing only--one's own experience. Everything depends of how relentlessly one forces from this experience the last drop, sweet or bitter, it can possibly give."
~ James Baldwin (1924 - 1987)
"Do it for the story." ~ Antoinette Nguyen, MD, MPH
Details, names, time frames, etc. are always changed to protect anonymity. This may or may not be an amalgamation of true,quasi-true, or completely fictional events. But the lessons? They are always real and never, ever fictional. Got that?
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