Life in Pictures: Spring Break Out!

Sun. Sand. Surf. Cousins. Classmates. Oh, and time off to enjoy it all. Good times, man.

***
Happy Spring Break.

Pebble-in-the-shoe times.

16 minutes.

That's all I have before I need to get dressed and get out of the door for today. But it's welling inside of me. This need, this urge to write.

And so I will. Forgive the errors in advance. They come with stream of consciousness writing.

Yeah.

Have you ever walked around with a shoe on your foot and felt something like a piece of gravel or some kind of something pressing into your skin with each step? Only to pull off your shoe and shake it and put it back on only to feel that little icky-sticky thing still there? Then, if you're like me, first chance you get, you yank it off again but this time your rub your hand and fingertips all across the insole in search of the whatever-it-is that is niggling at you.  . . but feel or find nothing. Nothing to explain it therefore no clear way to remove it.

Yeah.

And so. You just say eff it and walk around anyway with that irritating little prickle in your foot because, I mean, you have no choice. And eventually, if you're lucky, it either goes away or you're able to stop worrying about it enough to get on with wherever it is you have to go.

Yeah.

I have weeks like that sometimes. "Pebble-in-the-shoe" times I call them. Something is just a little off, a bit awry and I'm not sure why. My A game feels like a B- game and I become prideful and second-guessy about things that normally wouldn't bother me. Sometimes it's primarily at home. Sometimes it's at work. And on the ickiest days it's both.

Yup.

This week, it's mostly been on the work front. There's a tiny pebble in my shoe that has lingered all week. It started with a lecture I gave at a national meeting on Tuesday where, with each slide and word, I could feel that irritating little shard sticking me over and over again. And I'll even admit to you that it started that morning with me looking in the mirror and really, really not liking my hair which is still quite overdue for cutting. It was downhill from there. It was an out-of-town meeting and I hadn't packed the right clothes so what I wore also didn't feel right either. And yes, this probably sounds ridiculously trivial and vain to someone, but those who know me also know that I'm a firm believer in the look good, feel good philosophy.

Yeah.

So anyway. The lecture was fine, just not great, you know? Like the way the pebble doesn't cut your foot open or cause it to bleed but just makes the journey less fun. Yes. That. And I guess it has trickled into my week which is now on the wards at Grady.

Yup.

On Monday I start vacation. I'm whisking the kids, along with Zachary's best friend, away to the beach for a few days. Usually I don't clamor for such times but I think it may be just the panacea for what I'm feeling. That, and what I plan to do today.

What's that you ask? Well simple. I am going to do the thing that always, always makes me feel better when the pebble-in-the-shoe is happening at work. I am going to simply sit with my patients and talk to them. As a resident, I called it "heart rounds" and secretly still do. It usually happens in the afternoon after all of my "regular work" has been completed. I look at my list and simply go to the bedside. I pull up a chair and treat it a lot like that NPR show StoryCorps. I ask questions about their lives and just listen.

Yup.

I do a little of that every day on wards of course. But heart rounds is different because it is more intentional and separate from regular rounds. Time is carved out for it and there is no ulterior motive or information that I'm trying to gather for some management decision. It is just me plugging into humankind and downloading into my soul, my heart. There is no better place than Grady for that. I mean it. I'll let you know how it goes.

Well. There goes my 16 minutes. I went over by a few but that's okay. Writing is the other thing that shakes pebbles out of my shoes so thanks. Yeah. Thanks for giving me this space, this place to tell you all of this. Okay?

***
Happy Good Friday.

Bullies and Cool Kids.

*names changed to protect anonymity

"I wish that I could be like the cool kids. 

'Cause all the cool kids they seem to fit in

I wish that I could be like the cool kids

like the cool kids."

~ Echosmith

_____________________________________________

Medicine can be like middle school at times. Much like seventh grade, it's a combination of development, swagger, and perception. The early bloomers ascend to the top while the others settle wherever they can fit. It isn't always fair, actually. 

Someone deems a person "good" which, in the medical field, is like the equivalent of being considered "cool." Sometimes it's a faculty member or a colleague. Other times it's the nursing staff or junior group of admirers. What happens next isn't too far of a cry from junior high. Opportunities come. Shortcomings are quickly forgiven or even not noticed at all. And if a person is in the cool camp, life is good for the most part. 

Now.

In full transparency, I will share that my experience in residency was from the perspective of a person placed squarely in the cool camp. I remember when it happened, too. I was on my very first rotation as an intern and was signing out a late patient to my attending because my co-intern was in clinic. As I reached the end of my oral presentation and marched through the assessment and plan, my attending stopped, cocked his head sideways, and squinted one eye. 

"Remind me of your name again?"

"Kimberly Draper, sir." 

"And Kimberly where did you go to medical school again?"

"I went to Meharry Medical College, sir. In Nashville, Tennessee." 

He jutted out his lower lip and gave me a slow nod. Then gestured for me to carry on with the rest of my plan.  And that was that.

That attending was a key person on the faculty and a program leader. And I could tell that in that little glimmer of a second, he'd sized me up. The rest of our interactions were positive and he always seemed eager to teach me for the remaining time we had together. 

Sure. I worked hard as an intern and took pride in the lessons Meharry had taught me prior to starting residency. But I quickly began to realize that sometimes my lot in trainee life was better because of my position as one of the cool kids. Or rather, the good ones. 

As time marched on, I started to recognize a few other things, too. I started noticing that the cool kids are often privy to some conversations about the not-so-cool kids that aren't so nice. And I guess since I wasn't too cool in middle school, I've always felt a kindred tie to those who haven't been given a golden ticket. For that reason, those mean words always made me uncomfortable. But like any immature person who has found solace in the cool camp, fear of messing up a good thing can be a mighty muzzle. 

This got me thinking about an experience I had in residency. I had a co-intern who'd worked with me in the NICU during our first few months of internship. Sujata (name changed) was this very petite, soft spoken, and nervous young woman of Indian descent. She had a rather thickish accent but mostly it was her apologetic and anxious nature that drew the most attention to her. And that attention wasn't good, either.

Nope.

Sujata and I were on the same team that month and worked shoulder to shoulder on some very sick infants. In our extensive time together, I rapidly discerned that she'd been completely misunderstood. Not only was Suji highly competent, she was also smarter than anyone else working in the unit that month. That said, when the time came for her to defend her management or answer questions, with a tiny shake of her head she'd disappear into soft, mumbling apologies. It was awful.

Suji became my friend that month. Over that year, she looked out for me, too. Whenever I was on call in a unit or a tough rotation, without fail, she'd slide a tupperware dish into the resident lounge refrigerator with "Kim" written on a piece of masking tape stuck on top. Suji knew how much I loved her authentic South Asian cooking and never missed a chance to allow me to try whatever new recipes she whipped up. I appreciated that.  And mostly I appreciated her. 

But.

One day I was hanging out in the resident lounge waiting for sign out. In walks two "cool kid" senior residents, one of whom had already been chosen to serve as a chief resident the following year. Brent, the rising chief, plops down in a chair and groans loudly. 

"What's all that about?" I laughed.

"It's about the painful night I have ahead of me in the PICU." He plunged his hands into his hair and acted as if he was pulling it out. When I wrinkled my nose and looked puzzled, he clarified it for me. "Dude. Did you see who I'm covering tonight? I'm going to be up all frickin' night."

As soon as he said it, I knew who he was speaking about. He was referring to Suji. 

"Maybe she will be sort of helpful, Brent. You never know. . . she's gotten some more experience over these last few months." That's what the other senior resident said which I would have called him defending Sujata but won't since he was cackling the entire time.

Brent squinted his eyes and stared at his co-resident as if he'd just spoken the most asinine words in the world. "Dude. Did you say helpful? Sujata? Phsssssshhh. That chick is like an accessory nipple, man."

That line caused them both to explode in laughter. The other senior. while gasping to catch his breath, howled out loud. "An accessory nipple? What the hell? I don't even . . .bwah ha ha ha ha. . .wait, man. You gotta clarify on that one." He was already doubled over as he probed on this wicked one-liner partly because anyone who knew Brent knew that his quick-witted humor was unmatched--even when he was being mean. 

"Why an accessory nipple?" I asked, trying to look as genuinely perplexed as possible even though I wasn't. I knew that whatever he was getting at wasn't good. So I suppose this was my milquetoast attempt at a quasi-defense.

Brent propped his clogs on the dented up coffee table and leaned back on the chair. He was already chewing a big bite of the apple in one of his hands and nearly spat it all over the room when he added, "It's a perfect description. An accessory nipple is useless and just in the way. And most of the time embarrassing."  

And that? That was all she wrote. The laughing could no longer be contained. Brent literally fell on the floor and his co-senior began running in circles while screaming hysterically. And I just sort of sat there with this weird expression on my face which probably was some bizarre cross between uncomfortable and amused. You know, that way you look when you snicker at something terrible that you see on social media. 

But even worse was the fact that Sujata was my friend. I didn't defend her. I just sat there like someone watching a mugging in the street and feeling too scared to act.

Yeah.

On the way home I thought about the little babies that I'd seen in the newborn nursery with those extra mammary glands or accessory nipples. The parents pointing at the one, sometimes two little brownish peaks and asking if it was some sort of pimple or birth mark and me trying to explain through embryology that it was a "normal variant." Every single time, they'd look at me in horror as I tried unsuccessfully to reassure them about the random satellite teat that their sweet baby hadn't ditched in utero. Yup. Useless and just in the way. And most of the time embarrassing.  Pretty damn accurate description.

And this was the metaphor someone used to describe my friend as I sat by silently and allowed it. I'm still not certain why I didn't speak up, either. I'm ashamed of it even today.

Anyways.

I guess I am thinking about this today because I was talking to Isaiah about bullies yesterday. He asked me if anyone had ever bullied me. Quickly I told him "heck yes!",  reflecting on my awkward middle school years. Then he hit me with another question that got me thinking. "Did you ever stand by and let somebody get bullied without standing up for them?" 

He sort of pulled the wind from my chest on that one because instead of wandering back into high school or 6th grade, my mind squarely landed on Suji and residency. That "accessory nipple" line was one of many very, very mean things I heard about her without defending her. And so. I was honest. "Yeah, actually. I'm not so proud of that either." 

"Were you in 4th grade?" Isaiah pushed.

I twisted my mouth. "Honestly, son? I was a grown up. And some people who thought I was cool decided one of my friends wasn't. I was too scared of not being liked to speak up."

"As a grown up?"

"I know, right? I should have known better."

"Did your friend know that you weren't sticking up for her?"

I hate it when Isaiah's old soul rips the covers off of me. "Um. I sort of don't think so. Which I guess is the part that I've always felt bad about."

"Were you saying mean things about her, too, when she wasn't there?"

"Not so much. But sometimes I laughed."

Isaiah immediately looked disappointed in me when I said that part which sucked. "That's kind of being two-faced, mom." 

"Yeah, you're right. It wasn't cool."

"No, mom. It wasn't." It looked like he felt bad for giving me such a rough time so he added this to make me feel better. "But it's good when you think about something a long time and then realize a better thing to do. Like, now you tell us to always choose kindness."

I smiled. "Yeah. I guess you're right about that. And you know? It's good to let your kids and friends learn from what you did wrong."

"Yup!"

And with that, he ran off to build Legos. 

The part Isaiah isn't seeing is the part of me that now fights for everyone around me to feel like a cool kid--especially my medical students and resident learners. In all these years I've never shaken Brent's stinging words: "Useless and just in the way. And most of the time embarrassing." I don't ever want to feel that way nor do I ever want someone else to feel that way in my presence. Man, I don't.

Yeah.

I've not gotten it all fully figured out. And Lord knows that I still have my days where I don't advocate for folks like I should. But I'm better than I used to be. And what I know for sure is that the real secret to being a cool kid is believing that you don't need to be.

***

Happy Thursday. And hey, Suji? I'm sorry. 

Now playing on my mental iPod. . . . this. . .

and also this. . . . 

What we take for granted.

Today at Grady: 

Me: "Everything okay?"

Patient: "Yep. Everythang fine, Miss Manning."

Me: "Okay good. I just noticed that expression on your face."

Patient: "I guess it's 'cause I'm tripping."

Me: "Tripping off of what?"

Patient: "I was just thinking. . like every time I see y'all . . . it seem like you really, truly give a shit about me and whether I live or die."

Me: "I guess that's because we really, truly do." 

Patient: "Hmmmm."

Me: "Is there something wrong with that?"

Patient: "Naaw. I guess I'm just not used to people in my life giving a shit about much of anything. And especially not about me." 

Damn.

****

This is Thursday. And this is Grady.

"You can't be what you can't see."

I had an awesome afternoon at the Atlanta Youth Academy today. One of the kids asked me, "Who told you that you couldn't do it? That you wouldn't be able to become a doctor?"

My answer:  "No one. No one ever said I couldn't. Or treated me like I wouldn't."

It wasn't until I pulled away and drove down the street that it hit me what that meant.

Yeah.                                                                                                                                                    

***
Happy Tuesday.

Life is why.

Here is something I know for sure:

I can do just about anything I set my mind to doing if I just show up, try my best, and refuse to give up. This morning I woke up to a relentless rain on a day that I was scheduled to run a half marathon. A half marathon for which my training had left some things to be desired. When I picked up my race number the day before and heard about the forecasted weather, I was honestly feeling fifty-fifty about even showing up at all. To make matters worse, my morning MARTA train was delayed for technical difficulties and nearly threatened to make me miss the start time. Which would have been a perfectly acceptable excuse to turn around and go straight back home.

Yup.

Then I thought about something my friend Larry S., a cardiologist and Emory colleague, gave me last week. It was a lapel pin he'd gotten from an American Heart Association meeting with a pair of red running shoes and a simple statement on it:

"Life is why." 

He made sure to put it into my hands because he, a seasoned runner, knew that I was a relatively new one who'd been motivated by the loss of my sister to heart disease. I'm so glad Larry gave me that pin and thought of me that day. It was just the motivation I needed this morning. A reminder of why I run.

And so. I showed up. By myself. In the rain. Early in the morning. I tried my best. And didn't quit.

And you know what? It rained the entire time. Hard sometimes even. And it was cold, too. But guess what? I dug in, thought of my sister, and finished strong. I sure did.

So why would an already tired and already exhausted full-time working mother of two go out for a 13.1 mile in a chilly downpour?

Life is why.

Yeah.

***
Happy Sunday. How are you challenging yourself?

Match Day '15: It never gets old.

Match Day 2015

I keep waiting for Match Day to get old for me. For the giant clock on the wall striking twelve noon, the medical students sprinting for their envelopes, and the emotional pendulum that follows it all to seem blah and played out. At Emory, the location hasn't changed in years. Even the faces of a lot of the faculty members who stand around with our slightly less baited than our students' breath hasn't really shifted much either. Yet every single time, year after year, it feels magical to me. And brand new.

Match Day 2013

Admittedly the "odd" years are the most meaningful to me. As a small group advisor who has students graduating from the four year program on those years, these are the ones I've watched since their first day of medical school. But now that I think of it, the even years can be just as awesome. Witnessing their dreams come true on Match Day is a high that I will never stop enjoying.

Ever.

Beyond that is something else though. The level of investment I have in people changed since losing my sister in 2012. It's upped the ante significantly for me. Sure. I went hard before. But now that I realize how short life is and how critical it is to be a responsible steward of my influence and time, I go even harder. I decide more carefully where to pour my energy. And once I decide? I'm all in. 

I've talked about this before but it bears repeating. Out of the ashes of some of the most tragic life experiences can come unexpected beauty. I hold on tighter now. I want to water the flowers entrusted to me as dutifully as I can and then watch them grow. I yearn to roll up my sleeves beside the other gardeners who aren't afraid to get their hands dirty with me and then stand shoulder to shoulder with them as we marvel at the spectacular blooms before us. Match Day is a chance to present those flowers to the world in dazzling bouquets. Big, bold beautiful ones that we helped to prepare.

Match Day 2011

Yes.

I always take a lot of pictures on Match Day. I'm particularly mindful to snap images of those with whom I had direct involvement, especially during the clinical years and residency application process. I love going back and studying their faces. The elation so unfiltered and unlike what usual happy looks like. I guess it's just that I can see more into those pictures than others might. See, Match Day for most medical students is a day of glory. But me? I know the story. 

Sigh.

This year was like always. I met their parents. I met their grandparents, too. Shook their hands and tried to beat them to the kind word punch before their lips could even part. I told them who their children have been in their absence and let them know that they done good. I described the attributes that really, truly matter to parents--the ones that I now realize are the best ones. Especially now that I have children of my own.

"Your son is kind and has a heart for people. He is patient with even the most challenging patients and can find the good in everyone."

"Your daughter fights for what is right and stands up for those who may not be able to stand up for themselves. She expresses herself well and makes sure our patients are treated with dignity. She has a servant's heart and is an advocate for the least of these."

I didn't really talk about how smart they were. I mean, they're about to graduate from medical school and, for goodness sake, they got in to medical school in the first place. But since I know and I think their parents and grandparents know that it isn't really just about being smart, I give them those concrete words of affirmation. And for every kind word of gratitude they offer me, I trump them with some declaration of what I've seen in their child and the gifts they will offer the world.

That is, from my perspective as their teacher and mentor. And I win.

Yeah.

This is such a privilege. Each year I try and try to put it into words but feel like I fall short every time. Instead, I will just share some of Match Day 2015 through the eyes of this clinician educator and her trusty iPhone camera. The lens may not be high tech but for you to see what I see, it doesn't have to be. I especially love the ones of them holding up their Match notification letters. I love that in these photos they were looking at me and me at them. . . and how much of a dialogue is held in their eyes. Or that we were together sharing in a pivotal moment. Perhaps if you look close enough, you'll see it, too. And just maybe you might feel your pulse quicken, your heart skip a tiny beat, and your eyes sting with tears while you do. And even if you don't feel any of that, don't worry. . .  I had you covered.

Yeah.

Small Group Gamma, Match Day 2015

Best. Job. Ever.

That's it. That's all. Wait--and this. A certain medical student opening her envelope back in 1996.

Almost as exciting as this year.

Almost. 

***
Happy Saturday.