Old School meets New School.

*Warning: Completely nonmedically related and totally random post ahead.
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"I hope and pray that I will, but today I am still just a bill. . ."

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The Manning household believes in giving our kids a sho' nuff taste of the old school. Here's what we have been doing over here with our Sunday evening since finishing dinner and bathtime. . .

Whaaaaat???? What y'all know about that?

Oh yeah, baby. . . . thanks to YouTube, we've been rocking out to some classic School House Rock.


Real quick for the thirty-somethings and up--am I the only one who learned the preamble to the Constitution, the difference between a bill and a law, and all my parts of speech from these infectious little jingles? Tell me you didn't recite the preamble in a high school Civics class while pretending like you weren't singing the words to this:



You know you did. If you didn't, you are
a) not old school at all
b) somebody who grew up without a television on in your house on Saturday mornings,
c) not from this country, or
d) all of the above.

Awww. Is that you?

Okay, then let me school house rock you. This is how the Saturday ritual went down back in the day at least in my neighborhood:

• Every Saturday you woke up waaaay before your parents.
• You stumbled into the kitchen and poured yourself a giant bowl of Trix, Frankenberry, Cocoa Puffs, Sugar Corn Pops, Honeycomb, Frosted Flakes, Cap'n Crunch, or Apple Jacks.
• If your mama was on that "no sugar" kick (like ours periodically was) you instead poured a bowl of Rice Krispies or Kellogg's Corn Flakes OR-- as Harry just told me to add--that generic black and white box of just "Corn Flakes"--followed by ten heaping tablespoons of sugar that your mama had no idea you'd be slurping from the bottom of the bowl later. (Sorry, Mom.)
• You carefully carried that big-a bowl into the den, sat it on the coffee table, and then turned on the TV. (Remember when it had to warm up first?)
• Because there was only one channel with cartoons playing, even if you had several siblings, nobody ever argued over what to watch.
• Once the TV was on, you'd go back to grab the big-a bowl of now soggy cereal and sit criss cross applesauce on the floor.
• You watched cartoons from 8 AM to noon--moving only for the bathroom and to top off your cereal, after which, cartoons promptly were replaced by made for TV movies or sports.
• You did your chores.
• Your mama told you to go outside to play. For the day.
• You came back when the street lights came on.
• Oh, one caveat: If you played sports on Saturdays, you went to your game after cartoons.
• Then, when you got back, your mama told you to go outside and play. For the day.
• And you still came back when the street lights came on after riding your bike God knows where without a helmet and with a younger sibling holding onto the back of the banana seat and a next door neighbor riding on the tasseled handle bars.

Insert six year old on back (turned backwards), insert seven year old me riding, insert seven year old on handle bars.

Yeah, man. Four hours of cartoons pretty much on Saturday only and that was it. This is pre-PBSkids, pre-Disney Channel. . . .pre-cable! I'm talking bunny ears on top of the TV that sat on top of the other TV that was broken. (Y'all don't know nothin' bout the old school, man!)

But I'm sayin'. . . the Manning boys? Oh, they will know old school when the see it.

Starting with School House Rock. Here's our three favorites:







And I'm sayin' -- Zachary Manning? Oh he WILL bust out in song with any one of the above jams completely unsolicited. Especially "Interjections." Public places included. (I always feel proud when folks look at him all impressed-like at his knowledge of such old school cartoon classics.)

::smile::

Unfamiliar with the old school? That's okay. Get familiar--starting with School House Rock. And if you haven't already. . . get your kids familiar, too. (I'm just sayin'.)

The noun song. . . .


. . .but sayin' all those nouns over and over can really wear you down. . .


Zachary and I always hug each other at the end of this one. . . .



Darn! That's the end!

(Consider yourself School House Rocked.)

Heavy.

"So on we go
His welfare is my concern
No burden is he to bear
We'll get there
For I know he will not encumber me
He ain't heavy, he's my brother"

~ Donny Hathaway

Today I am thinking about trust. I am thinking about how although folks often talk about how little some people trust their doctors-- that there are a lot of folks that put a whole, whole bunch of trust in their doctors. And not just any kind of trust, but that save your life kind of trust.  Like, I know you've got my back no matter what kind of trust.

Compound that with being a black woman on the front lines of a county hospital and it gets even more complex. Like, you get me so you know deep down what I'm afraid of kind of trust. Like, I know you wouldn't let nothing happen to me on your watch kind of trust. 'Cause you get me. 'Cause I'm your auntie and your uncle and your sister and your granddaddy. 'Cause I'm your mama'nem and your Mudear and your play cousin. And sometimes, it's heavy.  Real heavy.

'Cause even though they are thinking those things, they aren't alone. I am, too.  I am thinking, you can trust me. I am touching your hand and using your language in a way that says, I do get you and I do know what you are afraid of deep down. And even though sometimes it's unrealistic, I am feeling, no, I won't let nothing happen to you on my watch. Even if it's out of my control.

So I pray. A lot. To fill in the gaps that reading journals and calling consults can't cover.

And today? After all of that, I stood in a bathroom stall and cried. Because a lot of times it is out of my control. And sometimes things do happen. Even on my watch. And today, it was heavy.  Real heavy.

So thankful I'm being carried, too.

***

"If I'm laden at all
I'm laden with sadness
That everyone's heart
Is not filled with gladness
Of love for one another. . ."

Dad, do you remember when you played this Donny Hathaway song for me when you drove me to medical school across the country? I know you don't. But I do. Especially today, I do. . . . playing on my mental iPod. . . listen and you'll feel me.

 

Thursday Top Ten: "Week on the Wards"

These boots were made for walking.

My friend Lesley M. told me yesterday that she loves reading my blog when I am on the inpatient service. Although the clinic has scored me some excellent blogworthy material, I'd have to side with Lesley on the abundance of experiences during ward months that make me want to run to my laptop.

And so.

With that in mind, I bring you this week's Thursday Top Ten: The top ten things I heard and/or saw at Grady Hospital this week on wards.

Oh yeah.

This reminds me--in the first week of the medical school curriculum, we have this thing called "Week on the Wards" for the first year students. I like it because it's a great baptism by fire for folks who may need to recognize that they have no desire to be baptized. Vomit on shoes, rounds that last a wee bit too long, rashes that give you the willies, and teeth so riddled with decay that you immediately schedule an appointment with your dental hygienist upon leaving---yes, my friends! All awaiting the youngsters who step their shiny shoes onto the wards for that first week. Now the good news, as always, is that all of those things get overshadowed by the human beings. . . . the wonderful human beings. . . whose hands you touch, whose life stories you learn, and whose lessons you internalize that leave you forever changed---even after a simple week. It leaves you saying, "I want to be a doctor."

As an M-1 student (first year of med school), you can't help but reflect on what you've seen and heard. But as an M-19 student, it gets a little harder. You have to remind yourself to marvel at and smile at what threatens to become mundane. So I guess I'm just trying to still hold onto the wonder of being new at this, and in a way, make every week a "Week on the Wards" experience.



Top Ten Things I Saw or Heard at Grady Hospital This Week:



#10 -- Consultation.

Man sees me in the hall at Grady.

"'Scuse me, don't you be on Fox 5?"

"Yes sir."

"Oh okay, then. Can you tell me what you think this is?" Lifts up shirt and shows me the side of his left flank which has what looks like an abscess.

"Uhhhh, does that thing hurt?"

"Yeah, ma'am. It do hurt real bad."

"Uhhhh, did you hurt yourself there or injure yourself?"

"I shot my insulin there, but tha's it."

"Hmmm."

"You could touch it, I don't mind."

"Uuuuh, yeah. Um, that's okay." I pause for a minute and decide how roped in I want to get. "Um, so that looks like a pus pocket and you need to get it drained and packed. If you don't you could get pretty sick. I think you should go to the emergency department."

"Yeah, tha's where I was headed, but then I seen you and said, 'Tha's that lady that be on Fox 5, so let me see what she talkin' 'bout.' So, now I'm fixin' to go over there to get it drained out."

"See?" I responded,"You didn't even need me. We was talkin' 'bout the same thing all along." I smiled.

"Sho' was, wasn't we?"



#9 -- Hair today, gone tomorrow.

A patient on her fourth hospital day said to me, "You know what I need? Some tweezers. I'm 'bout to have a goatee up in here if somebody don't get me some damn tweezers!"

Okay, so can I acknowledge that nearly every woman has at least one unruly hair that grows somewhere on her face that, although it does not lead to full on goatee status, if left untamed and unplucked could become something of great concern?

I know someone who shall remain nameless that made me promise that if she were ever in a hospital or otherwise infirmed and could not get to those wiry hairs that I would take it upon myself to take care of it. It's kind of like being a goatee godmother. Ladies: If you don't have a goatee godmother, get one. (I'm just sayin'.)

#8 -- Baby love.

A lady in the elevator had a baby that was so cute that it made my ovaries hurt. (Don't worry--only for 2.2 seconds, which isn't long enough to be dangerous.)

"That baby is beautiful. And look how happy he is!"

"He look like he want to go to you." And just like that she handed her beautiful little baby to me. Like she instinctively knew that I wanted to hold him. (I so did.)

I cuddled him all the way to my floor. I love Grady.

#7 -- Diet shmiet.

In the cafeteria:

Cafe lady: "Ma'am have you ordered?"

Me: "I'll have a turkey burger, just the burger."

Cafe lady: "Turkey burger! Plain! No bun! Next in line!"

Other lady: "Yes, I'll have a chicken breast. Just the chicken." Looks over at me and smiles.

Me: "Bread is the devil." We both laugh.

Other lady: "Yeah, chile. Tryin' to stay in these clothes." We both smile. I chastise myself for thinking that her treacherously tight clothing is already one biscuit over being stayed in. Smack my own hand. Shame on me for thinking that! Decide to think, Good for her for making a smart food choice because she did and she should totally get credit for that.

I smile at her again and nod.

Cafe lady: "Here's your turkey burger--you want any sides?"

Me: "No, ma'am. I'm good."

Cafe lady: "Chicken breast--sides, baby?"

Other lady: "Yeah, let me get some of them potato wedges you just dropped." Wait, huh? As in dropped in the grease to be deep fried.

Um, yeah.

Me: I know how I have a tendency to be all up in grown folks' diets. I immediately ask myself, WWHS -- What would Harry say? This is how I (sometimes) keep my big mouth from getting me into trouble: That's a grown woman and those potato wedges are none of your business. None of your business. Put a lid on it. Stay in your own lane, Manning. (Biting tongue until it nearly oozes blood.)

Other lady: "Alright then, girl. By the way, you be doin' good on channel 5."

Me: (tongue swelling due to intense biting as I watch her walk away with plateful of greasy mojo potatoes.) "Thanths."

#6 -- Boo who?

One of my patients took it upon himself to address me as "boo" for his entire hospitalization.

Sunday:

"Hey sir! It's Dr. Manning!"

"What's up, boo?"

Monday:

"Are you in any pain?"

"Naw, boo, but help me get these bowels moving, would you?"

Tuesday:

"Hey, boo, I like your outfit!"

Wednesday:

"Hey, boo--you'll do me a favor and see what time I last got my pain medicine?"

(Is it bad that I thought it was endearing?)

#5 - Weak on the wards.

I supervised one of the medical students as she attempted to perform a lumbar puncture on one of our patients. She wasn't successful even though her technique was perfect.

I wasn't either. A different doctor would need to do it.

The patient was fortunately gracious, and wasn't in much pain. I think it was a good reminder that just because you are an M-19 doesn't mean that you succeed at everything.

#4 - Hold it.

In the hallway:

"Hey, doc, can I hold five dollars right quick?"

"Hold five dollars?"

"Yeah. I'll give it back to you, I promise."

"Umm, I've never seen you before. Like, in my life, I haven't."

"But I'm for real, I'll pay you back."

"Uhhh, yeah. I'm gonna have to pass on that one."


#3 -- Be still my blogging heart.

Sitting at the nurses station:

Girl in a Georgia Tech sweatshirt approaches me.

"Excuse me, are you Dr. Manning?"

"Um, yes. . . . errr. . . yeah, I'm her."

Now smiling with big smile. "OMG, really? How fun. I read your blog, and I just love it."

Me, now smiling with bigger, goofier smile. "Rrrrreallly?" Ting.


"Totally! You're a total trip!" Walks off.

Hmmmm.

#2 -- Shout outs.

Had on my favorite green rain boots on Wednesday and a patient called out to me as I gleefully kicked puddles while crossing the street:

"What's up, Bootsy Collins!"

(If you know who Bootsy Collins is, you, too, would find this amusing.)

#1 -- Feed the chil'ren.

One of our octogenarian patients was accompanied 24 - 7 by her sixty-something year-old daughter for the whole hospitalization. This daughter was a grandmother and even a great-greatgrandmother two times over. She adopted everyone on the floor for the whole time her mom was hospitalized.

The other day I was rounding on her mom and was wrapping up the visit by chatting with them about our plan. In the middle of the conversation, two thirteen year old girls come in and hand her some money.

"Did y'all get what y'all wanted?"

"Yes, ma'am," they answered in unison.

"Did you get a drank, too? What you get?"

"I got the filet o' fish meal and she got the quarter pounder meal. And a apple pie."

"Good. Alright then, baby."

"Thank you."

The two girls walk off and go to sit next to the OTHER bed in the room with ANOTHER patient. I was totally puzzled.

"Are they related to y'all?" I asked.

"Oh, naaah. They with her." She gestured to the neighboring patient. I looked confused again so she clarified it for me. "Them chil'ren been here all morning and I axed 'em what they eat for breakfast. They ain't ate no breakfast. Then I axed 'em what they ate for lunch and they ain't ate n'an. I axed 'em why, and the chil'ren didn't have no money."

"So you gave them money to get something to eat? And you don't know them?"

"You can't let the chil'ren go hungry, baby."

"Wow."

"I don't have much. But what I has I give. And it seem like the Lord manage to provide for me long as I do stuff like that."

::sigh::

I love Grady.

Falcons fan and caring human being:
Taken and shared with her permission (from right after that moment. :)

***

Happy Thursday.

The woman in the elevator.

Yesterday I ran into that woman that I'd met in the elevator last year who worked in the cafeteria. She was the one who had taken it upon herself to bring a patient a special meal and two pieces of cake--because she had noticed on the patient's ID band that that particular day was her birthday.

It was quite a moment.

The funny thing is that I never asked her name that first day and I wished that I had. I loved how much pride she obviously took in her work. It actually made me want to do better. I kept thinking. . . anyone who would be kind enough to do such a thing (when no one was watching) just seemed like the kind of human being I wanted to know by name. And you know what? I wasn't alone. At least three other people at Grady Hospital asked me if I knew her name. Everyone, it seems, wanted to know exactly who this nice person was.

And so I finally had my chance to end the mystery. I asked her, "Do you remember me from that day that you let me take your picture in the elevator? I asked if I could write about you? I did write that story about you, but never got your name."

She looked at me with wide, surprised eyes from around the giant metal food cart. Kind of like, Who me? Which immediately made me feel a tiny bit ashamed that maybe people in long white coats usually aren't talking to her or even noticing her on elevators, even when accompanied by a six by six foot box of stainless steel on wheels. "I do remember," she answered. "I do."

"That . . .what you did. . .was one of the best things I have ever seen. Seeing you that day made me want to find ways to make my ordinary actions more extraordinary. I know that woman was so blessed by you that day."

"She was a prisoner. I know that it ain't my business why someone in a situation, but it was her birthday and she was a prisoner. She didn't have anybody to see her or make her smile or nothing."

I imagined this patient with her ankle shackled to the end of the bed--unfortunately not an unusual sighting in a public hospital. I thought about how easy it is to pass judgment on such a person, and how helping somebody on lockdown celebrate their birthday is generally not at the top of most people's to do list.

"What is your name?"

"Regina," she replied. She flipped over her work badge so that I could see it. "Regina L."

The elevator doors swung open on the tenth floor--my floor--but I let them close. Regina reached out to hold the door for me, but I waved my hand to tell her I would stay on and ride with her. I needed to tell her what I hadn't told her before. And I needed to tell her by name.

"Well, Miss Regina, you are something special. What you did that day was really remarkable.  I've thought of you often since that day and I'm so happy to meet you. I just wanted to tell you that."

"I 'preciate that, ma'am. I really do." She placed her hand on her chest and softened her eyes and voice.

"No, I appreciate you."

"It ain't every day you hear somebody say that to you. I don't even know what to say."

The lift had climbed up to the twelfth floor and had returned to ten again. Miraculously, no one else had joined us on the entire ride. I knew my team was waiting for me to start rounds and that I needed to go. I thought about my friend Crystal C., and something she once said to me:

"There is power in touch."

So I decided to touch Regina. To physically touch her. Before stepping out of the cabin, I reached out and grabbed her thin hand and squeezed it tight. "I'm so glad I saw you again, Regina. My name is Dr. Kimberly Manning, and I'm so honored to know you. Really." I covered the top of her hand with my other hand and held it for a moment.

She stood next to the enormous rolling box smiling as the doors swallowed her up and carried her off to the next floor. Just like that.

A name to go with the face.

Yeah, man.

Crystal was right. There is power in touch. Just like that first day when I met Regina. And just like that moment last year when she took it upon herself to bless someone for no reason.

Today, I think I'm going to do my best to channel my inner Regina. Maybe you can, too.

Extraordinary Grady.

Gram stains and growing pains.

gram negative rods

gram positive cocci in cluster

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"All I wanna do

is have some fun

I got a feelin'

I'm not the only one. . ."

~ from Sheryl Crow's "All I Wanna Do"

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"Are you enjoying yourself?"

"Am I? I'm loving it, Dr. Manning! This is so much better than the classroom. I am loving every minute."

This was the exchange that took place between Joelle, the newly minted clinical medicine student rotating on my team, and me this morning as we trudged up the stairs to go and see a patient. The entire team had just rounded on all of our new admissions from the night before, and Joelle stuck with me for my rounds on the rest of our  service of patients. I loved her answer to that question. It was so genuinely enthusiastic.

"That's wonderful," I responded.  "It's something to love, Joelle. It really is. Enjoy your patients as people. That way you'll continue to love every minute even when you've been doing it for a while."

She looked at me and smiled a big smile.  She was loving it.

In that moment, I thought about my very first clinical rotation.  Like Joelle, I too started on inpatient Internal Medicine fresh off the M2 truck carrying a stethoscope without any scratches anywhere and a short white coat free of so much as even a trace of ring around the collar.  And just like her, I was thrilled at the idea of finally getting to take care of real, live patients on a daily basis in the hospital.

Those first few days were rocky for me. I started out at the VA hospital, and felt swallowed up by it.  I remember standing on the wards listening to rounds and hearing the words flying over my head and whirring past my ears.

DNR, DNI, AMA.

"Excuse me. . . .uhhh. . what does 'DNI' mean?"

"Do not intubate. So like I was saying, this guy has terrible COPD and smokes like a chimney. He was demanding pain meds and got mad when I said no.  He wants to leave AMA." The resident spoke directly toward the attending with virtually zero interest in us medical students hearing, let alone getting what he was talking about.

"Pardon--what is AMA?"

The resident did little to hide his scowl at yet another question. "I'll go over some stuff with you guys after rounds," he replied.  This was his way of telling me to shut my piehole until they finished rounding.  It was one of the last questions I would ask that month.

We never did get around to that teaching session.

The following month was at another hospital. I remember being the student on a team with one intern and one resident. Back then, the lab closed at eight p.m. so any special things you needed overnight fell on the doctors. In our case, it fell on the medical student.

"Take this sputum upstairs and make a gram stain of it, okay?"

I remember raking through my terrified brain for some kind of remote idea of the steps involved in a gram stain. Gram stains tell critical information about the type of bacteria causing certain infections. The whole thing involves multiple steps which yield either germs that hold on to this particular stain (gram positive) or ones that don't (gram negative.)  The kind of antibiotic regimen, the urgency, and all of the management in many serious infections rides heavily on this piece of information which, for reasons that will forever escape me, the resident deemed me the appropriate person to obtain.

Um, yeah.

I recalled the times in our second year Microbiology lab where we'd done the gram staining process. Every single time I'd performed it, I'd done something wrong which always left a little too much stain on the slide.  And so. With me as the technician, everything was "gram positive."

Gulp.

I decided to come clean with my trusting/lazy resident.  "I'm not sure I am so good at the gram stain. Can someone help me?"

"No because we'll be doing a lumbar puncture on that other guy we just admitted."

I'd never seen a lumbar puncture.  I had read about them, yes. But had never seen one in real life. "Can I watch you guys do the LP first?"

Bubble expanding. . . .

"No because we need that sputum result."

Pop!

The resident didn't even look like he needed to think about it. Clearly my experience as a bright-eyed, bushy-tailed fresh off the boat clinical medical student meant zero, zip and nada to him. This was a done deal.  "Oh yeah," he added without even looking at me, "and take this urine, too. It's for that lady with pyelonephritis we just got. Spin it and gram stain it while you're up there." He held up a capped cup filled with a scarily cloudy appearing tea-colored urine specimen.  Great.

So I remember fumbling around in that lab praying that my very bootleg gram stain technique would not lead to some poor unfortunate soul receiving the wrong antibiotic. I panicked, thinking about how much scarier a gram positive rod is versus a gram negative one, depending upon the specimen. For a split second, I thought about throwing out all of the specimens, getting into my car, and driving west until I reached my Momma and Daddy's doorstep at home. I decided against that, considering there were sick patients involved.

I stained the sputum first. Gram positive.

Oh Lawd. 

Next came the urine. I spun it in the centrifuge, nearly catapulting across the room at first when I didn't close the top on the machine. Whoops.  I stood there praying that I would get it right while making the slide. I wasn't grown up praying--I was praying in that eight-year-old way you pray when you release a bowling ball into the lane and it's headed for the gutter.

Please Lord don't be a gutter ball. Please Lord don't be a gutter ball.

I felt like my bootleg gram stain was headed in a similar direction. Please, please, please. . . .gasp. . . is that. . .gram negative?  I am pretty sure I did the happy dance once I confirmed under the microscope that it was indeed gram negative rods---the typical and expected bacteria of a young woman with a urinary tract infection.

Hallelujah.

I made it back just in time to get handed a specimen bag full of spinal fluid. "Go spin this and stain it."

Nice.

This is what they call getting "scutted." I pretty much got scutted for the majority of that month. The good part of it is that me and a few of my classmates got pretty proficient at random laboratory procedures. The bad part is that I missed out on some high yield things, mostly because I was being sent off on scavenger hunts during all of the action. Even still, I can appreciate the experiential learning that I had while doing all of it. I guess.

But.

The worse parts of both of these months were my interactions with my attending physicians. I was pretty much invisible. And seeing as I have never been invisible anywhere, this was a hard pill to swallow. I will never forget the day that, after like ten whole days of being on the service and rounding with the team, my attending said, "Hello, are you going to be one of the student doctors here with us? What's you're name?"

"Kimberly Draper," I answered quietly, "and actually, I've been here for just about two weeks."

You know, the one that's been spinning down pee and staining up your patients' hocked up loogies all night on every call?! You know, the one that manually evacuated the horrifically constipated bowels of that ninety-nine year old woman two days ago-- upon your request?  You know, the one that introduced herself to you four times already this month?!? 

"Oh okay, then. Nice to meet you, Kimberly."  

Jerk.

From that moment forward, I made a vow. When I grow up, I will never, ever ignore the medical students. Ever. I will never not know who I am working with. I will never allow any hardworking human being on my team--be they a medical student, pharmacy student, pharmacy resident, Physican Assistant student, or visiting student--feel as invisible as I felt over those two months.  Ever.

Fortunately, I had some great role models on my other rotations who paid (sometimes too much) attention to us medical students. But I still will never forget that first rotation and how it made me feel about Internal Medicine.  I pretty much decided that I hated Internal Medicine based upon this experience, only to learn from one of my surgical attendings that "liking the patients on the wards but not the OR isn't really consistent with being a surgeon. That's called Internal Medicine, sweetie."

Ah hah.

I suppose being looked through or not important enough to be memorable after four separate introductions had left me feeling as washed out as those gram negative rods. As much as I'd wanted to hold onto some positive aspect of the experience, all I was left with was a faded version of it any time I looked under the microscope. Which sucked.

Yeah.

So for this reason, poor Joelle and countless other medical students on ward teams past and present  have been schlepped all over the hospital and up more flights of stairs with me than can be quantified. . . . .here, there, everywhere. Seeing patients. Listening to heart murmurs. Discussing hard diagnoses. Holding peoples' hands. And a few times, even looking at gram stains in the lab. But without fail, whenever we do that, we talk. About non medical things and fears and feelings. I try my hardest to find out the things I wish my attending had asked me back then. Like. . . .

"Where are you from?"
"What's your favorite food?"
"What are your hobbies?"
"Do you speak any other languages?"
"Where have you traveled?"
"What kind of talents to you have?"
"What are your mom and dad like?"
"Wow! You did a half-iron man?"


And stuff like that.


But I especially ask this one. . . .

"Are you enjoying yourself?"

Because now that I think of it. . . on many days when I'm teaching + learning + caring for patients at Grady. . . .all I wanna do is have some fun. And you know what? I've got a feeling I'm not the only one.

Olivier, a former student at commencement (with his parents) -- More than a gram-stainer, indeed.

In a bad mood? Watch this.

Fact: No one rocks out like a four year old. No one. (Not even a five year old.)

Oh yeah, and for those of you who don't have small kids, let me tell you this other fact. . 

Fact: The day your child learns to pump his or her own legs on a swing is the day you achieve park nirvana. This was my first taste of it.

(photo of Isaiah taken from a park bench without getting up.)

***

Happy Sunday.

The Big Deal: A Puppy Mafia Mystery

Puppy, the Godfather

Disclaimer #1:  If you have no idea what the Puppy Mafia is, please read this first.

Disclaimer #2:  Warning, extraordinarily unimportant, nonmedically related post ahead.

_____________________________________

"Mom? Tell me you'll look all over. Promise me you will."

"I have. I mean, I will. Look all over. Again. I promise."

"Thank you, Mommy. You're the best mom ever."

((hug))

That's what I heard every morning for an entire week at the bus stop with Isaiah last week.  And oh, did I fail to mention? Last week, something happened that could have had me two blinks away from almost thinking that I was a quasi-big deal. And you know what? I won't even be cryptic about it this time. I'll just flat out tell you that I was on the Dr. Oz Show last week, which technically qualifies as at least kind of cool. (In fact, very cool if you are my mom or my dad and it's the third time your child is doing it. . . .)

So wouldn't you agree that this could be deemed at least an six on a one to ten "deal" scale? Okay. So just when I started dusting off my (big deal) shoulders, I was quickly tapped on one of those shoulders by my so-called life outside of Grady. You know. . .the one where my big deal status is only in the eyes of two little boys under the age of five? Love how this part of my life keeps me fully grounded in minutia. . . . .

Okay. So instead of being focused on me and my quasi-big deal status, I had to put my mind on much more serious and pressing things. Why? Because of a serious development in the Manning household.  The unthinkable. The unspeakable. The (almost) unbloggable. . . . .

::sigh::

Dare I even admit it?  Okay.  After one full week of denial, I am forced to confess that. . . gulp. . .

DUN DUN DUN DUUNNNNNNNNN. . . . .

Puppy is LOST.  

Puppy. . .sigh. . .lost.  Not just a puppy. But Puppy.  As in Puppy the King Pen and Original Boss of the Puppy Mafia. Yes. The boss is lost.

And so.  I have done exactly what I have promised. I have looked. And looked. And looked. All. Frickin'. Over. I even drove through the neighborhood hoping for a merciful discovery like the one in a million experience we had with Pup Pup's great adventure.  No such luck.

The only thing worse than Isaiah asking me to look for Puppy every morning is Zachary asking me if I've found Puppy evening:


"Mommy, did Puppy get found yet?" 


"No, Pooda, Mommy is still trying to find him."


"Mommy, do you think he fell off your car like Pup Pup?"


"Did you throw him on Mommy's car like you did Pup Pup?"


"Nuh uh."


"Zachy? You promise?"


"Nuh uh."


"Nuh uh, you don't promise or nuh uh, you didn't throw him on Mommy's car?"


"Nuh uh."


"Zachary!"


"Mommy!"


"Did you?"


"Mommy?"


"Zachary."


"Can I have some apple sauce?"

Yes. This has been my life for an entire week. In addition to being responsible for a full service of (very sick) inpatients at one of the busiest public hospitals in America.

Even with a minor procedure, The Boss was there.

Okay, so this thing has become rather complex.  Ever since Zachary has begun randomly throwing members of the Puppy Mafia onto the tops of cars, the plot thickened exponentially.  So now, although I have torn up the play room, the bedroom, the laundry area, every hamper, every possible hiding place in our home or in our cars, in the back of my head I have to wonder. . . .did Puppy, in fact, get tossed to his death off of the back of a moving Volvo?

Well.

The odds are that, even if he DID (get tossed off of the back of a moving Volvo) the likelihood of him being lost forever and ever is lower than you'd think.  Why, you ask? Because Puppy (aka The Puppy Godfather) somehow always manages to get found.

Oh yeah--and he's "already brave."


Wait huh?

Let me explain.  In addition to the complex size of the Puppy Mafia, there is this other random aspect that I will do my best to explain to you--bravery.  Bravery, as defined and originated by the founder of the Puppy Mafia, Isaiah.

Heading to run errands, circa 2007.

"Isaiah, hurry up we need to go!"

Isaiah scurrying from the living room into the playroom -- "Okay, Mommy! Here I come!"

Runs up to me with two of his Puppies, Cody and Jack.  "You can bring them into the car, but you have to leave them there. They can't come into the store with us."

Isaiah stares at me for a few seconds. Then runs back to his playroom and returns with Puppy.

"What was that about?"  I just had to ask.

"Cody and Jack aren't brave yet. Puppy is already brave."

"Huh?"

"Puppy can stay in the car but Cody and Jack can't. Because they aren't brave yet."

"Uhhhh, okay."

So as it turns out, the "already brave" stamp is a bizarre designation held in the hands and mind of Isaiah and no one else. What deems a Puppy brave or not brave is classified information. Just when I think I fully know who is "already brave" and who isn't, I am corrected on my inaccuracy.

Okay. So if you are fully confused, don't worry.  Harry lives here and has no earthly idea how the hell the Puppy Mafia works.  He just hates hearing the kids crying, so he is willing to get involved only when a.) I am not home and someone starts crying about a Puppy, b.) I am fast, fast asleep and someone starts crying about a Puppy, or c.) I am pretending to be fast, fast asleep and someone starts crying about a Puppy.

So back to the fact that The Puppy Godfather is likely to return:

This isn't his first time getting lost. At. All.  In fact, Puppy's first big disappearing act took place a few years ago when Isaiah took him to my grandmother's house in Alabama. It was the weekend of our college alma mater's Homecoming weekend, and Mee Ma had a housefull.  My whole family went to college at Tuskegee and homecoming involves a family pilgrimage every fall. This was one of the first few years Isaiah and Zachary came down thanks to my (wonderful) Dad volunteering to bring them and the rest of the grandkids and keep them while we hung out with our friends.

But.


The time came for Daddy and the grandkids to head back to Atlanta that evening.  Dad loaded all them all into my brother's Suburban and just as he was clicking the five point harness car seat belt, Isaiah asked:


"Pa Pa? Where is Puppy?" (Or as he used to pronounce it back then "Pubby.")

"Pa Pa will find it. Don't worry." And in Pa Pa goes to retrieve Puppy.


Okay. Now seeing as Pa Pa is old school, I mean for real ol' school, he walked into Mee Ma's house and looked around for a few moments and said "bump it." It was getting dark. It was time to go.  Pubby would have to either get found later or Isaiah would have to find a new lovey. (Or as my friend Kym says, "You in a bad way.")

Anywho.  Before I left I looked through my grandma's house, too. Well, it turns out that when your eighty-something year old grandmama lives in a house that she has lived in since before they had color TV, cable TV, or DirectTV there's a whole lot of stuff that accumulates there (especially TVs.)  And I'm just sayin'. . . . while my grandmama's house is neat, I am saying that there are far too many nooks, crannies and crevices for me to be finding a little stuffed dog.


So check it.  That was in November of 2008.  Mee Ma looks all over for the dude for months and no such luck. Isaiah would randomly announce how much he missed Puppy or how much all of Puppy's brother's missed him, and all I could do is call my Dad and (try to) make him feel bad. (Didn't I mention that he was old school?)


So fast forward to November 2009.  Pa Pa remakes the pilgrimage with grands in tow, and would you believe that Isaiah strolls straight into Mee Ma's house and finds Puppy within two minutes of arrival?  I am NOT KIDDING.  After a full year of being AWOL.  Me, my dad, my grandmama, and my mama were jumping for joy.  Isaiah just looks nonchalant and tells us, "I knew he was okay because he's already brave."

Bananas. (I won't even tell you about Puppy getting lost in Cleveland, Ohio or in our backyard.)

So the deal is, based on his track record, Puppy always manages to find his way home. So I'm hoping that this time will be no different.  But in the meantime, Pup Pup has now been promoted to Godfather and officially has achieved "already brave" status.

Was Puppy set up? Pup Pup, The Interim Boss--can he be trusted?

So. In between taking care of my inpatients at Grady Hospital and meeting every deadline that is looming in between, I will be fielding questions about the untouchable and currently unfindable, Puppy.

*I welcome your suggestions on where he might be and welcome you to leave your vote on whether or not you think he will be found. A simple  "It's curtains for Puppy!" or "The Boss never dies!" will do.

See? Now how random is all of this? Told you I wasn't a big deal.

***

Don't let the sweet face fool you. That patient is really a mob boss.

Happy Saturday.

Thursday Top 10: On my honor.

And now, Zachary has become a don in the Puppy Mafia.

I heard this guy speaking recently who was talking about leadership and success and getting ahead and achieving overall awesomeness-slash-genuine happiness. So obviously, there's a lot that can be said about that but of the many things he said, one thing stood out for me. He raised one eyebrow, and karate chopped his flattened palm with the other hand when he said (in his wonderfully staccato Austrian accent):

"Everything is a choice, my friends."

Uhhhh. . . .were you waiting for something deeper?

Ha. Well, he clarified that, of course, choosing things like getting a terrible illness, an unexpected loss of life or fortune, etc. was not what he meant by that. He meant that we have choices in our day to day operations. He went on to say that essentially being excellent is a choice, and that being happy is, too.

"I choose to drive home toward my wife thinking, 'I love her and I am looking forward to seeing her.' I choose to get a shoe shine so that I will look presentable, and I choose to personally sign every check coming from my business. Success at everything is a series of little choices. So is failure. Happiness, real happiness, is a series of choices. So is being miserable."

I was on the edge of my (previously hard and uncomfortable) chair. (I figured I had better choose to see it as sturdy and ergonomically correct instead.)

"Why not focus on the good a bit more so that you will be drawn to it? It is a great way to honor the life you've been given. Focus on being excellent at everything as much as you can through your little decisions. Do you know what happens when you do? It's contagious."

Real talk.

So, here's the thing. This week had been kind of crappy for me. In fact, very crappy. It started with me accidentally picking up and using an old book of checks from an old account on Sunday. It was from the same bank, in the same kind of box, but should never have still been living anywhere in my house. On Monday, Harry was at the bank making a deposit and asked me, "What's up with this deposit slip? This account has been closed since before Zachary was born." Errrr. . . yeah. I was supposed to shred them a while back, and obviously hadn't.

Oh, and did I mention that I had written a couple of checks before I'd realized the error of my ways? Oh, and did I mention that they were to. . .uuuhhh. . .my church?

Yikes.

So my church--yeah, my church--received a wonderfully empty offering from this well-meaning member who happens to be a sho' nuff and bona fide doctor of medicine-- from a closed account. (As it turns out, church folks are real nice about letting you square such things up, but I digress.)

So that's how the week started. And it didn't end there. A few more crap-tacular things took place which was giving this week the overall thumbs down--before it was even over.

But then, I remembered what The Choice dude said that day. I decided to choose to focus on the good things that had taken place in this week to see how that would affect my overall view of it. Turns out he was right.

And so. . . .in the midst of a week that gave the best college try ever at being worthy of throwing juicy tomatoes in the direction of at breakneck, fast-pitcher speeds. . . . .I CHOOSE to bring you this week's top ten list:

The Top Ten Great Things That Have Gone Down So Far in an Otherwise Crappy Week

#10

I received an email from my friend Kris R. that was so sweet and so unexpected that it brought me to tears. It was a simple note sent after she'd walked her son to school telling me that she valued our friendship and believed in me. Simple as that. We don't email each other often, but it made me so happy because I feel the exact same way about her.

#9

I visited with my mother on Tuesday who had just gotten back from a trip to Los Angeles. My aunt Renee passed away last month, and Mommy and others in my family flew out for her memorial service. For multiple reasons, I couldn't go. Mommy let me look at all the photos on her Facebook (ha ha, love that) which made me feel like I was there when combined with her narration. That was pretty great.

#8

I got my hair cut. As y'all know, I love getting my hair cut. But the other thing I like is the whole energy of black hair salons. Almost everyone knows everyone and for some reason, no one seems to have a filter on what they say. One sista-friend came in with a hat on her head after work. She couldn't even put her purse down before three other sista-friends peered from under dryers and behind magazines saying, "Girrrrrrl! What you do to your hair??!!" Ha. Love that place for all the same reasons that I love Grady.

#7

Woke up this morning and smiled because I knew what would happen when I see one of my favorite senior faculty Grady doctors, Dr. Lubin, today.

He will see me in the hall and predictably announce: "Hey Manning! You got a hair cut!"

To which I am scripted to say: "Yup! I got all of 'em cut!"

Dr. Lubin and I have been saying that to each other about our hair cuts for the last ten years without fail which--now that I think of it--warms my heart.


#6


Harry sent me a random text that simply said, "Love you.'' He managed to do that at the exact climax of the crappiest part of my week. I needed that.

#5

All of my second year medical student advisees started their clinical rotations. Yesterday, I saw Marla, one of that group, sitting on the Grady wards in her crisp white coat. She was learning from Brett, an intern that I have known since he was a medical student, too.

I loved the excitement in her eyes as he taught her and the excitement in his eyes to be teaching.

#4

My five-year-old MacBook Pro ran out of memory and this week, it got more memory. Yay.

#3

I spent over an hour talking to my mentor and favorite Grady doctor, Neil W. I realized while writing this list what a wonderful resource, cheersection, motivator, role model, and friend he has been to me. Neil makes me laugh until I am sick but also manages to be one of the only people other than my Dad who seems more interested in my career than me.

And.

He is ridiculously smart. Yesterday I told him that he was my "Human Answer Key," which I am laughing about because I should have pronounced it "YOU-man Answer Key" since that's how he pronounces words that start with "hu." Anyways. I run all confusing cases by him, and even had him on speaker phone when my dad had a few medical questions last week. When I was doing my board recertification knowledge assessment modules, Neil even went over an unspeakable number of questions with me--which, if you ask me, goes above and beyond the mentor job description.

I'm thankful for that funny, smart and selfless guy.

#2

I received an acceptance letter for a manuscript I sent for consideration of publication in "The Annals of Internal Medicine." Here's the thing: The manuscript was a story about a patient that deeply touched me and many other people. Knowing that so many people will be able to meet this prince of a man made my week.

Neil and I were talking earlier this week about ways to honor our patients. We health care providers meet some pretty amazing people and get to often know the most intimate details of their lives within two minutes of meeting them. It feels good to give something to someone who has given so much to me.

#1

On Monday it rained so hard that I referred to it as "a monsoon" to my kids (who promptly asked, "What's a monsoon?") As we drove through the monsoon, Isaiah and Zachary started spontaneously singing in the back seat:


"It's raining today, it's raining today
Hello rain, hello rain. . .


I want to go outside and play, I want to go outside
Hello rain, hello rain. . .


Raindrops fall, raindrops falling down
Everywhere, all around. . . "


And just like that, my own raindrops started falling. I remembered where I'd learned that song and when I used to sing it. From my Auntie Renee. I can see it like it was yesterday. . . .when I was in elementary school, my T'Renee used to sing that with us while driving us in her car on rainy days. Just like Isaiah and Zachary, my sister, my cousin, and I would be in the back seat belting out those words as she tapped the steering wheel to keep us on beat.

::sigh::

It was a full circle moment that reminded me of how much I loved my T'Renee. And just when I was feeling bad and conflicted about not being there at her memorial service to honor her . . . . .my children's pitchy rendition of the song she'd taught me years and years ago reminded me that I had been honoring her. . . . all along.

***

Happy Thursday.

Substitutions OK.

hug it out.

 Rx:

 Hugs P.R.N.  (as needed)

Refills: unlimited

Generics and substitutions OK.

Today while sitting on the wards writing notes at Grady:

"Excuse me. . . "

I look up and a pale, thin youngish woman is standing on the other side of the nurses' station.  She was wearing two hospital gowns, one forward and one backward, but what stood out most was this big smile on her face. It was almost scary big, actually. Anyways, there were several resident physicians and students scattered around the area doing work. Although this patient's scary big smile was nonspecific and seemed to be aimed at everyone, for some reason, she zeroed in on me.


Aaaahh, of course she did.

"Yes, ma'am?"

"Can I ask you a question?"

Oh Lawd.  This wasn't a "do you know where financial counseling is?" or "can you tell me where the restroom is?" kind of "can I ask you a question."  It was loaded. Kind of like the day that man totally caught me off guard with the race question last year.

"Sure, ma'am,"  I finally answered.

Why not? At worst it would be slightly inappropriate like asking me to discharge her or take out her IV right now or write for some kind of narcotic pain medicine. At ultra-worst it would involve me getting up off my tukas and escorting her somewhere way out of my way or her being psychotic. At best it would be amusing-- and at ultra-best it would be blogworthy.  (I'm always keeping my eyes open for new material.)

Now here's what's funny.  I was thinking blogworthy like . . . . like that day Roy A. called me to tell me that there was a dude standing in the middle of the Grady atrium playing a rusty trumpet.  Okay, so I was already gone that day, so didn't get to see it with my own eyes, (but I still deem it a suitable example of juicy blogworthy material.)

Anywho.  I didn't know what this lady was going to ask me.  I was about to find out.

With her scary-ish smile, she quietly asked. . . .

"Would you be willing to hug a stranger?"

Wait, huh?

"Excuse me?" I asked for clarification. I couldn't help but notice every other person getting exponentially more industrious with whatever they were being industrious on.  Ummm hmmmm. Their looks said. . . .

Hug a stranger? A stranger with a scary smile? Awww hell naw!

I kept staring in her direction and she repeated herself. "Would you be willing to hug a stranger?"


Lawd. She is serious.

But she was looking at me, not them. And she almost looked a little bit tearful.  So I made a quick decision. Why not? Let's hug it out, man.


I walked over and gave this stranger with the scary big smile a hug. Afterward I step back and notice that she is crying. For real, crying.

"You have no idea. . .no idea how much that meant to me. I get to go home today. . .and I'm so happy. I'm going home."

"That's great," I replied.

This lady was not my patient and I had never seen her in my life. I had no idea why she was hospitalized, and still don't. But what I do know was that she seemed to genuinely need that hug.

"And you know what else?" she gushed, "I got a job! I just found out I got a job." She started tearing up again and began wiping her eyes with the heels of her hands. She took a big sigh and regained her composure. "I'm just happy, that's all. That's why I needed a hug. So thanks for that."

And just like that, she turned and walked down the hall.

Wow.

Blogworthy indeed.

little superhero brothers need hugs, too.

Haiku on the first day of March wards. . . .

Back on inpatient
Opening my eyes and heart
My "standard of care"