Control.

Hey! It's my 300th post!  (Just thought I'd mention that.)

 __________________________________________________

***

"Got my own mind.

I want to make my own decisions.

If it has to do with my life. . . 

I wanna be the one in control."

~ Janet Jackson

____________________________________________________

I've been taking care of a few patients over the last few days who haven't been very nice to me.  One of them flat out told me to "Go Away, dammit!" when I tried to perform my examination on rounds today. She swatted my hands off of her and shooed me out of the room--for, literally, no reason that I could think of. 

Yeah.

I was tired from working over the weekend and from Zachary waking up repeatedly and whining while getting dressed and from Isaiah crying this morning before getting on the bus and from driving between Grady and Emory in the middle of the day for what has felt like the five trillionth time this month, so honestly? I just wasn't in the mood.  At. All.

I was alone.  There were no medical students with me or residents or even a nurse overlooking. I was super tempted to put my hand on my hip, let my backbone slip, and curl my lips. I was ultra tempted to grab up my cantankerous patient by the gown, stare at her nose to nose, and growl, "I WILL NOT go away. You WILL sit up and you WILL let me examine you and I will NOT be putting up with this TODAY! GOT THAT, LADY?!"

But I didn't.

Instead I just did what I could in between her exaggerated lip smacks and throaty insults; laying my quivering stethoscope any place that could possibly give me some answers and not a hand slap.  Okay. I'll admit that I was seething and had a rather funky attitude as I quietly told her the plan and halfheartedly asked if she had questions.

She did have one question: "Can you please just go A-WAY?" She then smacked her lips (very hard) and turned her back to me in a way so exaggerated that it looked planned and blocked by a director for a medical drama. "GO A-WAY!" she repeated.

So that's exactly what I did.

I wish I could tell you that I said something super poignant that allowed us to connect and then sing kumbaya. Nope. Not at all. I was tired. And I wasn't in the mood to be gracious.

After that patient, I went to see another patient who had decided early in his hospitalization that being nice to me or anyone else was not a priority.  He had gone from screaming and spitting mad, to eerily calm, to angry f-bombs, back to scary docile--all over a four day period. I had no idea what to expect this day, and truthfully? I wasn't even in the mood to find out.

Turns out that today was sarcasm day.

"Hey there. . .it's Dr. Manning."

"Well, well, well!  If it isn't DOC-ta Manning!"

"Hi sir. How are you feeling today?"

"Awesome! Just awesome! In fact, I could not be better!"

I cleared my throat and rubbed my neck.  "Umm, okay. Any pain today?"

"Let's see . . . .pain.  Um yeah! Everyone here is a pain in the ass! Does that count?" He gave me a sacchariny-sweet smile (complete with aftertaste.)

I pursed my lips and blew outward. Not. In. The. Mood. "Sir, are you moving your bowels okay?"

"I sure am!  But I'm not sure how since I barely eat this ridiculously disgusting diet! It's an absolute, f--ing joke. But, hey,  I am still AWESOME. Totally AWESOME."

I did my best to acknowledge the psychiatric aspects of his behavior. But it was hard today. And I won't even lie--all I could feel was annoyed. I felt myself crumbling.

"Look, sir.  This isn't helping anything. And I'm not about to stand here and listen to your profanity. I'm not. Not today, I'm not."

"Is THAT RIGHT?" he chided in an even more horribly cynical sing-songy tone.

He was totally pushing my buttons.

"That's RIGHT."

"Oh, well NEWS FLASH! I do what I WANT TO F--ING DO, ALRIGHT?"

I pressed my lips together and sighed hard.  "You know what?" I started and then stopped. It was the kind of "you know what" that precedes somebody getting cussed out on the corner or after dealing with a rude cashier.  I wanted to go straight L.A.--I take that back--straight INGLEWOOD on him, giving him back exactly what he was giving. I closed my eyes, gripped the bed rail, and tapped my foot to release the mounting frustration.

Lawd, Jesus. Help me to be more like you.  Whew.

I looked at his tray and the clear liquid diet that his condition required him to eat.  I glanced at the tubes and IV lines coming from every limb of his body. His youngish face was twisted and frustrated. His eyes narrowed and I braced myself for the venom that I saw him preparing to spew in my direction.

As I examined him, expletives whizzed past my cheeks and punched my shoulders. The worst ones you can think of. You've read all about my many tender moments at Grady--but there was nothing tender about this. At all.

In between f-bombs and grating sarcasm, I did my best to repeat the the plan to him that my team had discussed earlier that morning.

"I will speak to the specialists," I said with every drop of exhaustion that I was feeling evident in my voice. "As soon as they tell me what they recommend, someone from our team will be back to review that with you."

"GREAT, Dr. Manning! AWESOME!  Tell you what? I'll see you back in what, like, FIVE BILLION hours?!" He let out a cackle and squeezed his eyes shut.

I'm sayin'. .  . really?

I just stood there staring at him. I could feel my blood boiling.

I couldn't take it anymore. I walked out to the nurses' station, sat down and just put my head down on the desk.  I was tired. I was sick of hearing it. I closed my eyes and did my best to channel something. . .anything. . .to get me in a better place.

That's when, all of a sudden, this image of eighteen year old Janet Jackson followed by the word "CONTROL" underneath it popped into my head like a giant TV caption.

CONTROL!

Ah hah.

Kind of like Janet, that's really what we all want to some degree.  It's why Zachary was crying this morning when I wouldn't let him wear his big red rainboots to school and why Isaiah was giving me the business about wanting to be "a walker" to school and not a "busrider" and why I was so aggravated by my patients being so difficult. Control.

"If it has to do with my life--I wanna the one in control. . ."

The profanity? The refusal to cooperate? All ways to regain control for people whose unfortunate medical, social and psychiatric conditions had left them with virtually none. These two patients were frustrated with minds and bodies that had turned their backs on them -- which, truthfully, had little if anything to do with me or anyone else.

I finally admitted to myself that I was bent out of shape because I couldn't bend them in the direction I want them to go. No amount of kind words or soft intonation was working. Things that usually work for me. To control a situation.

Ah hah.

So today, despite what someone else might think was the right approach, I stopped trying. I went back in to see those two patients again; this time making up in my mind that I wouldn't make it about me. Because it wasn't.  On this day, I decided to let my patients have the control that they, too, craved by simply controlling me -- even if it meant getting pelted with a shrapnel of f-bombs, "go aways", and extraordinarily rude sarcasm-- and even if giving it to them was at the expense of just a little bit (okay, maybe a lot) of my own pride.

Funny. Once I looked at it that way, I somehow felt better about it all. And more in control.

***


"I'm in control. . . .and I love it."  ~ Janet J.

Heartwarming.

Today on rounds. . . .


This is a snapshot of the medical student on my team with one of our patients--performing their own little "morning ritual."  Each day on rounds, this patient warms up the student's hands before she performs the exam. It's been their own little thing between them that, normally, no one else is around to witness.

But today, I was.

a therapeutic touch. . .

And now you were, too.


The power of touch goes both ways. . . . . yeah.

***

Happy Sunday.

Happy.

This morning:

Isaiah:  "You know what, Mom?"

Me:  "What's that?"

Isaiah:  "I'm so happy."

Me:  "That's good, Poops.  What are you so happy about?"

Isaiah: "Mom. . . .sometimes it's good for you to just be happy on the inside."

Me:  "Preach, pastor."

Blowin' up.

Random Grady elevator moment:

I'm riding on a random elevator one random day and in steps this gentleman who appears to be somewhere between forty and fifty. He has bandages over his arms and lower legs, and someone has attempted with painstaking detail to cornrow his hair into several tight-ish braids which are fraught with peril considering that his probable European descent afforded him baby fine, stick straight hair. The giant jersey he was wearing was swallowing him up like Jonah in that whale, but this look was intentional for sure. Bandages or no bandages--this dude could not be more content. He tapped the bottom of his box of cigarettes, getting himself ready to go outdoors for a good smoke.

"What's up, doc?" he spoke with a raspy voice.

"Not much. You doin' alright sir?"

"Yeah, main. I'm doin' good now. But real talk, doc, I'm sayin', Grady pretty much saved my life!"

"Wow. That's great. Car accident?" I immediately jumped to the thing we are most known for--trauma.

"Naaawww! I got burnt! Like bad. Guess what happened, doc?" He kept tapping the box of Newports. I liked his voice. It was somewhere between Wolfman Jack and Samuel L. Jackson which, combined with his slippery cornrows, ginormous neck tattoo and surprisingly toothless grin, made him memorable and decidedly blogworthy.

"I can't even guess."

"My house. It jest blew up, for real. Like 'BOO-YOW!'"--he added in some jazz hands--"That sh@& straight blew the f--- up. It was crazy, doc!"

I decide that I am amused at people who randomly feel comfortable dropping happy f. bombs in the presence of complete strangers.

"Wow, that sounds crazy! Looks like you were really fortunate."

"Hella fortunate."

"Were you in the house?"

"Yeah, main. . . . but I got my azz up outta that piece. Then it was like 'BLAAAMMM!' Windows was breakin' and all kinda sh@%! I'm sayin', I coulda died for real."

"For real for real," I cosigned.

"Yeah. . . they was all like, 'What happened, folk?' and main. . . .I just laughed and told my peoples, 'Shiiiiiddd, I'm blowin' up!" He laughed at the play on words. I did, too. "Tha's so they wouldn't be all worried and sh@$."

Wow was he at ease with his potty mouth. I tried to picture his whole crib imploding windows and all.

Hmmmmm.

"So . . . .like. . .what made your house blow up, though? That sounds kind of crazy. . . .like. . . what were you doin' in there?" Immediately after I said that I chuckled, but then suddenly froze -- putting my hand over my mouth and widening my eyes.

Right then we reached the ground floor and the doors flew open. He slid a cigarette out of the pack and placed it behind his left ear. With a throaty laugh he stepped out of the cabin ahead of me.

"See, now doc? Now, you askin' too many questions."

And with that, he bid me adieu and headed off to smoke his square.

Being the nerd that I am, I entertained a differential diagnosis for things that might make entire houses blow up. Not a very long list.

Hmmmmmm.

Yeah, doc. You asking too many questions.

T.G.O.F. (The Gradys on Friday.)

Random sampling of stuff I heard and said today at Grady:

***
"How you doing today, sir?"

"Me? Awww, baby, I'm easy like Sunday mornin'. . ."

(If you don't know nothin' 'bout that--peep this jam from the Commodores circa the 1970s.)



***

Me:  "Hey there. Just coming by to check on you again."

My patient:  "Ooooh!"

Me:  "What?"

My patient:  "I 'in't knew you had all that gray in yo' hair!"

Me:  "Yeah. I got a hair cut so you can really tell since I'm due for color."

My patient:  "Ooo, Jesus, doc. When you gon' get it colored, baby?"

My stylist insists that I'm five years away from this.

***

Patient:  "Do y'all think this is cancer?"

Intern:  "That's a good question. What we can say is this: The scan looks concerning for something like cancer. But the only way to know is to get a sample of it."

Patient:  "You mean a biopsy?"

Intern:  "Yes, ma'am."

Patient:  "Well, go on then and let's find that out. And listen to me and you listen good--if it's something real bad, I don't won't nothin', do you hear me? Nothin'." 

Me:  "We promise to let you know what the biopsy shows the minute we get it. Then you can talk things over with your family to see what you all think is--"

Patient:  "My family?  No! This is MY BODY. I will make decisions about MY BODY. My family? They love me and they gon' want everythang no matter what. And this?  This MY BODY. And don't nobody need to talk nothin' over with me about MY BODY."


Silence.

Patient:  "Do I make myself clear?"

***

An environmental services worker walks by after cleaning the area. She smiles and says hello as she passes our rounding team.

Me:  "Hey--is that money pinned on your shirt because it's your birthday?"

Lady:  "Yes!"

Me:  "Awww!  Wait a minute--"  (pinning a dollar onto her uniform) "--there you go!"

Lady:  "Thanks!"

Med Student:  "How old are you today?"

Lady:  "Twenty one!"

Team in unison:  "Happy birthday!"

***

Student:  ". . .and that's our plan for her."

Me:  "Would you like some feedback on your presentation?"

Student:  "Yes!"

Me:  "Pulak, my dear, you sound like an intern. That's my feedback. You sound exactly like you are already an intern."

Student:  (big grin) **ting!**


***

 Patient transporter:  "You got kids, right Dr. Kim?"

Me: "Yep."

Patient transporter:  "Yeah, I figured 'cause you got little bit of that mummy-tummy like me."

Dayum.

***
"Standing in a patient's room talking to him and his family. Dinner trays are being passed.

"What's in there?"

I open the tray.  "Broth."

"Broth and what else?"

"Jello."

"It ain't no steak in there?"

"Nope. Just broth and Jello."

Pauses for a minute. Then does the old school Florida Evans move from Good Times. 

"Daaaaamn! Daaaamn! Daaaaaaaaamn!"

Hilarious, do you hear me?

*(Note:  All black people between the ages of twenty-five and fifty-five hear this and know exactly the moment and the scene from Good Times when this took place. If they don't, they automatically deemed imposters.)



***

Nurse:  "He seems confused today."

Me:  "He can't be confused."

Nurse: (looks at me puzzled)

Me:  "He told me I was lookin' slim and trim today."

Nurse:  "Aaaaah."

Me:  "So clearly he can't be confused."

Nurse:  "Clearly."

***
 
T.G.O.F. and T.G.I.F. to all. :)

Thursday Top Ten: The Best (Match) Day Ever

Match Day.

To employment! (That's cider for me--I had to go back to finish rounding.)

Today was match day. The day where all of the fourth year medical students all over the country rip open envelopes that determine where they will be doing their residencies. A day full of angst--the sonic boom heard all over America after a nearly four year drum roll toward being a doctor.

Today was that day.

Emory School of Medicine, today as I crossed the street

For the nonmedical folks reading this. . . .here's how it all works:

You decide on a specialty after doing all of your clinical rotations.
You make sure that your choice of specialty matches up with your performance in med school.
(Certain specialties require otherworldly board scores and grades, etc.)
You gather your letters of recommendation.
You apply through the computer application system.
You wait to hear from programs and if you're lucky, you get a bunch of interviews.
You interview.
You fret about which programs in which cities you liked the most.
You fret some more.
You pray, if you're into that. (I am.)
You rank the programs in order of where you want to go.
(Little do you know that the programs are fretting, too.)
The program puts in their lists in order of who they want.
You hope and pray that the folks who you liked like you back.
On Match Day, you rip open an envelope and find out.

My Match Day Moment, March 20, 1996

Yeah. That's pretty much how it works in a nutshell. I remember that day for me. I was so freakin' happy. Like so happy. My first choice of programs wanted me, too. And most importantly, as my father quickly reminded me, I was gainfully employed.

Yay.

I am doubting that this was cider (but don't worry-- I didn't have to go back to round!)

We had a big ol' party where we signed each other's scrubs, toasted a few too many times, and graffiti'd our names all over a giant map with our residency locations. That day was awesome. And as you can see above. . . . I sho' nuff celebrated.

So with that said. . .even though I always have enjoyed coming to Match Day at Emory each year, never has it ever even come close to the enjoyment I had on my own Match Day. Not even close.

That is. . . . until today.

*Gasp* 

 I can't believe I'm saying it. . .but it's true. This year was the best Match Day ever.

***

Quick background: In 2007 our School of Medicine overhauled its curriculum. The remix included sixteen faculty members appointed to advise small groups of medical students and teach them over a longitudinal experience for all four years. I was one of those lucky sixteen faculty members.

So in July of 2007, I met these seven students who, along with many other students in the class, I came to know and love very well. The nature of the curriculum created these family ties in our small groups that leaped above and beyond any teaching experiences I'd ever had. And it trickled from one small group to the next, like neighbors standing on porches handing cups of borrowed sugar to other peoples' children. All for a cake that in the end everyone would be invited to come over to enjoy.

Yeah. Like that.

I'd advised students before, yes. I've taught students, too. But this? This was different.

Never have I known learners so well.
Never have I been so invested.


That's why match day this year destroyed my careful application of drugstore mascara. Yes. Completely annihilated it--and any chance of anyone ever using the word "stoic" to describe me--all with what bordered on "the ugly cry."

I told one of the students today:

"Imagine how you feel right now. Now multiply it by all of you students and take that value to the fourth power for every single year I've known you. Then you'll know how I feel."

And so. Here is your Thursday top ten. . . .the top ten reasons (in no certain order) why this was the best Match Day ever. . . .

. . . . and why I now know for sure that I am walking in my purpose.

***


#10 The Excitement.

It's impossible to describe the excitement of the day.  You can see it in these faces, though.

#9 The Anticipation

They can't legally release the results until noon on Match Day. Here's a few shots of people waiting with baited breath. . . .

That clock is for the countdown. . .

Preclinical onlookers: "We got next."

#8 The Moment.

Some times a bunch of words just don't suffice.

a nervous student

a proud mother

a dream realized

first choices aligned again

Another proud "mama": Dr. B., one of the head advisors.

In the presence of two gentlemen both headed to Harvard for residency. . . !

Disbelief by some, relief by most, pride by all.

Over the moon

A job with benefits, too!

Words from the wise.

It's a family affair.

***

# 7 through #1: My Small Group.

The seven wonders that I have had the pleasure of watching grow since their very first day of medical school orientation. And seven reasons why if this wasn't my job, I'd sure wish it were.

Look at these shots and you'll know how long I've known them. . . .
I've watched them growing up right along with Isaiah and Zachary . . . .

Zachy wasn't even walking yet!

Zachy less than a year old with Adam less than a year into med school. .

Wook at dat two year old Isaiah!

. . . and here we are today as serious doctors. . .

. . .well, sort of serious doctors. :)

May I introduce you to my seven wonders--and part of medicine's future?

Each is described in four words, even though four thousand would never suffice.

And don't worry--I can tell you that the future of medicine looks bright.

***

Alanna.

Thoughtful. Empathic. Mature. Empowered.

Internal Medicine, UC San Francisco.

***

Hreem (pronounced "Rim").

Driven. Organized. Focused. Confident.

Ophthalmology, Rush Medical Center Chicago.

***

Jin.

Insightful. Compassionate. Loyal. Patient-Whisperer.

Anesthesiology, Walter Reed Army Medical Center

***

Ant.

Activist. Inspiring. Memorable. Brave.

MD/MPH Candidate, to enter OB/Gyn Residency 2012

***

"My Three Sons": Dougie, CQ, and Sparky

(Gainfully employed sons, that is.)

Tony.

Talented. Magnetic. Fighter. Winner.

Otolaryngology (ENT), Henry Ford Medical Center

***

Adam (aka "Sparky").

Selfless. Dependable. Passionate. Incredible.

Internal Medicine, Barnes-Jewish/Washington University St. Lo.

***

Doug (with sweet wife, Anne)

Caring. Gracious. Focused. Funny.

Anesthesiology, Mount Sinai Medical Center, NYC

***

Oh happy day.