Haiku on a Monday morning : Fresh.

 ***

Another Monday

Another chance to become

The me I strive for

***

Shoe-icide.

The Dansko clog: PTSD culprit

These are my weekend hospital work shoes.

My husband thinks they look like scary orthotics. And if I am not mistaken, he also has suggested that if he only saw one of them, he'd bet money that they belonged to someone with asymmetric leg lengths.

Ain't that some mess?

The good news is that I don't wear them anywhere other than the hospital on ultra-long inpatient rounding days. The man hates them, yes. But they are ridiculously comfortable, even if you have to stand for a gazillion hours in a row, which is why I purchased them in the first place.

Oh--let me clarify. I don't not wear them elsewhere because of Harry's opinion about them. The truth is that I pretty much agree with him for the most part. On most days, I'm not a "clogs" kind of girl at all, and the girly-girl in me is often willing to commit shoe-icide for fashion's and for husband's sake. What can I say? A good pair of it-girl high heels makes me happy. Which is fortunate considering I sho' nuff married a see-his-wife-in-some-car-to-bar-scary-high-heels kind of man.

Okay.

Now, here's the funny part:  since work on the weekends is just about the only place I rock these hand-stapled Danish atrocities, it has created a Pavlovian reaction for Zachary who hates it when I have to round on weekends.  If I so much as take them out of the closet, the dude hits me with the sad-face.  His bottom lip gets to quivering and he wails:

"Not the shoes, Mommy! Not to work, Mommy!"

Well just tear my heart right out of my chest, why don't you?

Okay, so is it bad that every time I had to round on weekends last month, I left the house wearing my Ugg boots (which I am in 24-7 around the house and that Harry calls "grounds for divorce") and then changed into the Dansko's in the Grady parking garage? Shoot. It was either that or see a four year old cry.

See? These are the kinds of important dilemmas I face before going to stamp out disease every day. I'm just sayin'.

What kind of crazy things are y'all dealing with in your neck of the woods?

***

Happy Sunday.

Four sticks.

*names, details, etc. changed to protect anonymity. . . you know the deal.

image credit

_________________________________________
Middle-of-the-night, Pediatric Ward - Internship 1997.

"I just wanted to go over the procedure before we do it, okay?"

She nodded quickly as she sat in the bedside chair next to the empty bassinet. Her youngish face was pretty, even without makeup. The over sized sweatshirt that she wore clearly belonged to someone else; her tightly folded arms were lost inside of it, barely offering a glimpse of her trembling fingertips. Two moments later, a man came scurrying inside with car keys jingling in his hands.

"Hey. . ." He looked at her first, immediately grazing her cheek with his lips. Then he faced me, fully alert. All business.

"Honey, this is Dr. Draper. She was just about to tell us about the procedure. You know. . .for the fever."

He gingerly sat down next to his wife but kept his eyes focused on me. With a tight-lipped smile he raised his eyebrows and gestured for me to carry on.

I nervously shifted the three pagers clipped onto my lopsided scrub pants and cleared my throat.

"Hi, sir," I extended my hand to introduce myself. My hand is shaking. Why is my hand shaking? Relax. This is a straightforward procedure. We do this all the time. Poke out your chest. Look confident like your resident always looks.

I cleared my throat to fight of my building nerves. "Okay. So the thing, I mean, the procedure that we are going to do on baby Jasmin is called a lumbar puncture. Have you ever heard of that?"

They looked at each other for a moment and then back at me. He spoke first, but more to her than me.

"Kind of like when you had the epidural, I'm thinking?"

"That's what I was going to say," she added.

"Umm, well yeah. . .it's kind of like that. Since she has a fever, we need to get a sample of the fluid that bathes her brain. . ." I realized that this sounded kind of macabre, so decided to revise that statement. "Since she has a fever and she's less than a month old, we like to exclude all kinds of infections. We check the blood, the urine, do a chest x-ray, and then we also look at the spinal fluid. Just to be, you know, safe. We start the antibiotics and send all of these tests to the lab to see if there are any germs that could be causing a serious infection."

"So this is why she needs the . . .what did you call it?"

"Lumbar puncture or spinal tap," I answered the father. "To make sure everything is okay. If no germs grow, we will be a lot less worried."

"So . . . .is it. . .does it hurt her? This test?" the mom queried. "Like, should I be in there with her?"

I internally recoiled at the thought of this worried mother being present as we folded her firstborn child into a fetal position. I saw my wobbly intern hands trying to obtain a sample of spinal fluid and shuddered, hoping they didn't catch it. "Um, well. . .you. . .well, usually we would just have you wait, you know, here in the room."

"How big is the needle they use?" the Dad asked.

I hated these kinds of questions. There was never a right answer or an answer that I felt was authentic. I was thinking, It's a big ass hollow needle with another smaller needle inside of it. But I didn't say that. Instead I simply said, "The spinal needles are special ones for this type of procedure. The ones for grown ups are pretty large, but the one we are using for Jasmin is the smallest one we have available." There. That wasn't so bad. Even if I never answered his question.

Dad rubbed Mom's shoulder and kissed her hard on the side of the forehead. Her nose was red on the edges. She looked like she was going to cry.

"We need to have you sign this consent form before the lumbar puncture, okay?" I slid the sheet over to them on top of the nearby tray table. "There is a very, very tiny risk of infection, uhh, bleeding, and. . yeah. . .mostly those things but it is really, really rare." Based upon my extensive experience. Um, yeah.

They both just sat there staring at the paper with all of that tiny writing on it. Finally, Mom took a pen from her purse and scrawled her signature across the bottom of the page. I wish I could say I felt anything more than relief. Relief that this would be moving on along and that I didn't have to page my upper level resident. Relief that she had signed the consent and especially relief that she wasn't demanding that she be there while it was taking place.

I know. That's terrible, right? I mean, how could even I admit that? How dare I? But the thing is. . . . it was true. I was more than half way through my combined Internal Medicine and Pediatrics internship at this point and I had spent more than nine months trotting behind an upper level resident and working obscene hours. The senior residents had the added complexity of supervision; backing up every failed procedure and emergency and being the one who told their haggard interns to "go ahead home" long before they could. What that means is that my main role models were often emotionally and physically exhausted, so they taught me to value things like efficiency, persuasiveness, and pseudo-confidence.

So that's why I felt relieved. It meant that I would be able to get into that treatment room quicker. That I would get a chance to "get" the L.P. on this baby. And just maybe, if I was able to do it in "one stick" and if the lab reported that the fluid was free of so much as a trace of red or white blood cells, I'd get a three A.M. high five from my senior resident--and a cold ginger ale from the patient nutrition room in celebration of my "champagne tap."

I peeled myself away from that room with those worried parents and then into a pair of sterile gloves, size six-and-a-half. As my senior sat nearby on a stool while eating a bag of microwave popcorn, I coached away the tremor in my right hand before starting. I made eye contact with the nurse who was helping me by holding baby Jasmin in position.

"You ready, hon?" the nurse asked me while tightening her grip around Jasmin's lower legs and nape of neck.

"Okay. I'm ready," I said.

And then, after numbing Jasmin with anesthetic, I commenced to advance the spinal needle into Jasmin's three week old vertebral space. With my resident coaching me from his perch, I forwarded it until I met resistance.

"Pull it back and go up a little. You have to kind of head for the head a little bit," he smacked. Pulling a grease covered hand from his popcorn bag he demonstrated the "proper" technique in the air for me while squinting his eye for effect.

So I tried again. And again. And again. Until finally, my resident was forced to dust of his salty hands, wash them, and then put on his own pair of sterile gloves. Eventually, he pulled out that inner needle and clear spinal fluid dripped from Jasmin's tiny back. I then took his place, collecting four separate tubes of the water like liquid to send to the lab.

The nurse strategically placed one band-aid over the four tiny puncture wounds just above her gluteal cleft. One bandage for the four "sticks" that Jasmin endured.

I still remember following my resident out of that room and to the nurses' station where he went right on chomping on those kernels while dictating how I should label the specimen. The main thing I felt was disappointment with "not getting it"--that is, needing to have the upper level step in and successfully complete the procedure. Not so much as a thought about the fact that somebody's baby just had just gotten stuck repeatedly in her back. That was my concern--not Jasmin. So much for that high five and that ginger ale toast.

Jasmin was handed back to her parents swaddled tightly; she had fallen fast a sleep after her marathon of high pitched crying from being held into a jackknife position by a nurse vice grip and being prodded with a needle. Four times. Mom and Dad hugged her and kissed her. And later thanked us even. They were none the wiser.

After that, we went to go eat the Chinese food that the medical student had squared up during our jaunt in the procedure room. I'm pretty sure we didn't speak much of Jasmin again. That is, with the exception of a reference to her being unusually chubby for a three-week old, explaining why "maybe you found it tough to feel your landmarks."

Yeah.

Today Zachary was playing "hide and seek" without notifying us that we were supposed to be seeking. He was crouched under a blanket on the bedroom floor, and my two hundred-plus pound husband unknowingly stepped right on top of him causing him to let out a high pitched yelp. As soon as Harry realized what happened, he quickly scooped crying Zachary up rubbing his face and repeatedly kissing the tiny finger that he'd trapped beneath his shoe. I scooted beside them on the couch and joined into the consolation. We both hate seeing either of our children in pain.

That's what got me thinking of Jasmin.

Today I am reflecting on how different my perspective has become on caring for human beings now that I have children. I feel sad when I think of how often during my training we habitually depersonalized ourselves from our patients; especially during procedures. I'm not saying that we didn't care. We did care. But somehow the culture during those days of unmonitored duty hours led many of us to operate outside of ourselves; going through the motions when we were tired and compartmentalizing the people from the procedures. Even children.

I have cried on more than one occasion while watching my kids get immunizations. When I imagine those parents and their worried faces, and then when I recall how easy it was to separate them and Jasmin from that lumbar puncture. . . . I cringe. I cringe even more when I recall the countless other Jasmin's I encountered along the way. I'm ashamed of that to this day.

Oh, and that horrible consent process I subjected them to? Uggh. That's an entirely different and equally disturbing story for another time.

All I can say now is that I am really happy that this part of medical training has evolved. A lot more time is spent humanizing our patients and respecting them as people more than objects. I recently read this reflection written by a current Pediatric resident blogger and knew it for sure.

And thank goodness for that.

Yeah. Zachary's smushed finger ended up being fine. But I still wonder how those parents felt when they took off that band-aid and saw those four needle marks on Jasmin's back.

***

My baby: Puts a lot into perspective.

Thursday Top Ten: The Slammer.

___________________________________________________

Today's top ten is based upon (one of the many) random discussions that I had this week with my five year old son, Isaiah. As many of you know by now, we have a lot of random conversations. I knew this would be the top ten the minute he started off with this question-- live and direct from the Volvo:


"Hey, Mom? What are, like, ten reasons why somebody might get arrested and have to go to jail?"

Um, yeah. This is what the dude asked me from the back seat on Monday. Just out of the blue. Why ten? I do not know.

Okay. Now at first, I must admit that I was bothered by this question. I hit him with a barrage of queries exploring what would make him ask me such a thing. But then I had a change of heart when two very simple truths popped into my head.

1. Does the kindergarten backseat question ever really have to be for a reason? (Answer: No.)
2. My sweet, angelic manchild just happens to be born into a demographic of folk who disproportionately get faced with the answers to that question. (I mean it is what it is,) So as far as I'm concerned, this might be a good conversation to start early just in case it comes up later.

Therefore. . . .I plunged into answering his question. And those who have or have had or have been around kids this age know first hand that the first answer to such a random question is:

"Well what do you think?"

Aaaahhh. . . .which brings me to this week's top ten: The top ten reasons (according to Mommy, Isaiah, and Zachary) why somebody might get arrested and have to go to jail.

(In case you didn't really know.)


THURSDAY TOP TEN

#10

Mommy: "You might get arrested if you walk out of a store with something you didn't pay for."

Isaiah: "I think that's called shoplifting, Mom."

Mommy: "Oh, uh, yeah. That."

#9

Isaiah: "What if you crash your car into somebody and just drive away!"

Mommy: "That'll get you put in cuffs for sure."

Zachary: "What if you are driving a Batmobile?"

Mommy: "You'd get a pardon."

Isaiah: "What's a pardon?"

Mommy: "Like an extra chance to not have to do something if you did something bad."

Isaiah: "Or like when you get to watch TV on a school night."

#8

Mommy: "If you don't take care of your kids, you can get arrested and go to jail. Like not feeding them or bathing them."

Isaiah: "Did we take a bath last night?"

Mommy: (thinking about it) "I think you guys didn't."

Isaiah: "Hmmmmm . . "

#7

Isaiah: "If you deface school property they could put you in jail, Mom. For real."


#6

Mommy: "If you have taxes and you don't pay them, they might put you in jail."

Isaiah: "What's taxes?"

Mommy: "Something that you'd better pay when you grow up so you don't get put in jail."

Isaiah: "Oh."


#5

Isaiah: "If you call 911 and you are just joking, they can put you under arrest, Mom. For real."


#4

Mommy: "If you are being violent and you don't keep your hands to yourself you might get arrested and go to jail."

Zachary: "For fighting?"

Mommy: "Yep. That's why fighting isn't such a good thing to do."

Isaiah: "No, you can fight. Just don't start it."

Mommy: "Or you could just avoid a fight altogether by walking away."

Zachary: "Daddy said if somebody hits me I need to hit them back."

Isaiah: "Right, Mom. As long as you don't start it. For real."

Mommy: "Uuuhhh, okay."


#3

Zachary: "Hey! What about a wobber?"

Isaiah: "It's robber."

Zachary: "A wobber would get arrested."

Isaiah: "No, a robber would, though."


#2

Mommy: "If you break the law you can go to jail. That's why you have to follow rules. Laws are like rules for everybody. Like stopping when you see a red light."

Isaiah: "You sometimes turn when the light turned red, Mom."

Mommy: "Okay. Well I'm talking about other kinds of rules and laws unrelated to that arrow on Briarcliff that turns red after like, five seconds."


#1

Zachary: "Hey! I bet you if somebody had a wet bottom and slid down the slide and then everybody kept going really, really slow on the slide after that they might get arrested."

Mommy: "Or at least they should be, Zachy!"

Zachary: "Yeah, Mommy. Because sliding down the slide when you knew that you had a wet bottom is NOT COOL!"

Mommy: "So not cool."

You never know when you might need this little card.

***

Happy Thursday.

Chutzpah and cojones.

On my way home from the American College of Physicians Meeting. . . .

I was in this horrifically long line for the security checkpoint the other day at LAX. Despite me making it to the airport in fairly good time, it was not looking good. I chatted with a friendly Australian gent as we inched along the infinite queue at what was surely slower than a snail's pace. Being my normally conversant-with-strangers self, I obliged him when he gestured toward the line with the elbow of his folded arms and said:

"Pretty bad one, eh mate?"

I smiled wide, especially since he called me mate. (Although it made me secretly wish he'd preceded with G'day.) I shook my head and replied, "It ain't looking good for us, my friend."

He laughed and blew off an exaggerated sigh while plunging his tanned hands through salt and blonde-not-pepper curls.

Turns out that he had traveled all the way from the South Pacific and was passing through Los Angeles on his way to Sin City for a big gambling trip. "An all night, all day flight, mate!" he'd said.  I cracked a few jokes to him, mentioning that despite being from L.A. (which is driving distance from Vegas) and living in Atlanta (which has America's biggest airport), Vegas has just never been my thing. Partly because the lights give me a headache after while, but mostly because I am Virgo-cheap and unwilling to play more than fifty cents in the quarter slots.  "Hold up," I said, "You came all the way from down under to go to Las Vegas? Are you, like, a Poker pro or something?" He gave a hearty chuckle and simply shared that, unlike me, he (and most of the world) loves Las Vegas. And not in that Cirque du Soleil or Celine Dion kind of way, either. . . . but more in that kiss the dice, "baby need a new pair of shoes" kind of way. Nice.

So there we were. Chatting about all things random. Me. The Aussie. A couple heading to a cruise for their thirtieth wedding anniversary. Three young women from a Big Ten university track and field team. A lovely Latin family speaking melodic Spanish to each other and English to us while heading back to Atlanta after visiting family on the west coast. All of us. Eking along in this serpiginous line that seemed to have no end in sight. Yet. All in good spirits and in all-for-one-and-one-for-all solidarity as the real, true chances of missing our flights loomed like a heavy cloud.

"We could always meet up in the food court and gamble with our buddy here," I teased.

"Ay, I have a deck of cards, mate!"

We all laughed.  It was like one big, happy, late, stuck, multicultural family.  Despite how crummy it was to be in the airport at six-something in the morning, spirits were surprisingly high.  And like I said--It was all good.

Until.

A man and a woman come blasting up the pathway on the other side of the roped off area enclosing our line. Hustling all the way to the front panting while frantically rolling luggage behind them. They finally reach the security officers manning the check points that we'd been (slowly) approaching for the last hour plus.

Now check it. How 'bout these folks had the unmitigated gall to tell the officer lady that "Their flight is about to leave in fifteen minutes" and "there is no way they will make their flight if they have to wait in that line."

Wait, huh?

That security lady gave those folks one of the hairiest eyeballs ever given to another human being. She craned her neck down the line and then said, "So what do you suggest I do? Better yet, what do you suggest I do when these five hundred people jump over this podium and assault me for letting you ahead of them?"

The man uttered another ultra-entitled explanation with a huffy little clearing of his throat, "I don't think you understand, Miss. We are about to miss our flight. Do you hear me? Miss our flight."

The Security-Mama looked from side to side like, Wait, is he talking to me?  Then she said, "Um, sir. I cannot let you all ahead of these people. Period. I suggest you get to the end of the line because it's still growing." He parted his lips to say something else and she repeated herself, this time with her voice rising waaaaay over both his and our ambient chatter. "You need to get in line sir." He spun on his heel and marched off while muttering discernible expletives under his breath. His wife scurried behind him with a worried look on her face.

So guess what happened next?  How 'bout they got in line and commenced to ask person after person if they could go ahead of them. And the thing is. . . . you have to give them props for this approach. Because seriously? It was working for them. They were rolling up that line like gangbusters, ignoring the scoffs and eyerolls that people subjected them to before saying "Uggghhh. . .go ahead."

Boom! Bam! Bam! Boom! These folks were making great time. It was crazy. Person after person. Stepping aside and letting Mr. and Mrs. Entitled ahead of them.  Bananas, I tell you. It felt kind of like a reverse of that show where everyone stands by passively as someone is getting mistreated. You know, the one where the train wreck continues until one person finally pipes up and gets that congratulatory interview from that ABC News dude. . .what's his name? Yeah! John Quinones. That dude.

Anyways. As foul as this man had acted to the Security-Mama and as much as they both had done to jack up our kumbaya vibe in the checkpoint line that morning. . . .they really didn't deserve to be let ahead.  I even heard the Mr. Entitled say that they were trying to make a connection for their vacation and didn't want to miss it as his wife moaned over and over again that she knew they should have left earlier like she said.  In other words, they just didn't want the hassle of missing a flight.

Hello? Is this thing on?

Okay, well. . .regardless of all that they continued to Bogart their way toward the front. And baby, they were making it happen. The Entitleds had made it through just over the half way mark of the line and were soon quickly approaching me, the Aussie gambler, the Big Ten hurdlers, the lovely Spanish-speaking family and the Re-honeymooners who were proudly standing at about the two-thirds point. By now, I could hear what they were saying to each person:

"Hi, excuse me, would you mind if we went ahead of you? We have a connection that this flight meets and if we don't get on this flight we will miss that connection. . . .Thanks."

I heard this two or three more times, followed by "Sigh! Go ahead" until finally they were like, literally, two or three people away from me.  It was becoming as repetitive as the "Can you hear me now? Good!" line from that Verizon guy and I began wondering what I would say when they reached me.  I leaned over and asked the Aussie-gambler what he thought. He laughed and said, "I don't know, mate, what do ya think?"  Just as I prepared to reply to my down under pal, a loud voice screeched the needle on the record:


"Oh HELLL no! You ain't getting in front of me. Hell no, do you hear me? Hell no." 

 I swing around and see this really put together thirty-something year old cocoa-complexioned woman staring forward and shaking her head. She tightly gripped an iPhone with one hand and held the strap of her designer purse with the other. No eye contact. No nothing.  Just solid in her resolve and in her hell no.

It was awesome. Like a crazy Seinfeld episode.  I loved every minute of it. The college track girls covered their mouths. The Aussie snickered out loud. The Entitleds tried to plead their case but she wasn't having it.

"Ma'am, we have a--"


"I HEARD what your situation is.  Everybody here got a situation. I got a flight I might miss, too. You ain't getting in front of me. HELLS no." 

The man was ever audacious and surprisingly wasn't intimidated by her direct block. He moved forward a bit more and said with his nasal-y voice, "Look, lady. You don't have to be rude about it. All of these other folks"-- he held his hand up toward the legions of milquetoasts he'd just trampled over-- "were kind enough to let us by! Like we said, we will miss our connection if we don't make this--"

"SO! SO DAMN WHAT!" This time she looked him dead in the eyes. "Did somebody DIE? Is somebody getting MARRIED in two hours? Are you about to miss a SEVEN DAY cruise?"

"No, but we--"

He tried to ease past her as he spoke and she put up a hand stopping him with her elbow.  "Man,  you better GO ON with that BULLSH%@!  You and your wife AIN'T getting in front of me. I mean that. I don't give a damn WHERE you got to go." She shook her head and curled her lips, but still kept up her elbow guard rail. "I have no idea WHY you think what YOU have to do and YOUR flight is so much more important than these other five trillion peoples' flights. Look, I can't speak for the rest of these folks but you got me MESSED UP for somebody else if you think you gettin' in front of me. HELL NO."

OMG! I looked around to see if John Quinones was about to jump out with his microphone to shake her hand and tell the rest of us that we suck.  The couple just stared at her incredulously.  Then, she turned and ice-grilled them saying with a pointed finger, "I can't believe how ENTITLED you all are. YOU should of got your ass up EARLY like EVERYBODY ELSE. You in a BAD WAY this time. Oh, and you BET' NOT step ahead of me, either. I mean it. I been here since six-in-the-damn-morning. And you AIN'T getting in front of me. HELL. NO."

Daaaayuum!  Dude. . .do you remember that time when Sophia snapped on Mister at the table in The Color Purple? Wait. Was it Mister or that man when she was at the store? Either way, the way she said "HELL. NO" sounded just like Oprah's Sophia, man.  It was like THAT.

A couple of people gave like mini-claps, but this lady was so serious that everyone was a little bit scared to say anything. I kind of wanted to reach back to give her a fist bump for having the cojones to say what everyone else wanted to.

After all of that, she looked down at her phone and industriously began scrolling through it. In other words,  that was the end of that.  Oh, and if you think those people got a single step in front of that woman, you'd better think again. Like she said: Hell to the No.

Okay.

So today I'm reflecting on chutzpah and timing of chutzpah.  In a recent conversation with a few members of my medical student small group, we discussed the importance of picking your battles and deciding when and where to take a stand.  Now, maybe some of you might think that the woman who shut down Mr. and Mrs. Entitled should have just let it go. . . .but I have to admit that something about her. . .her chutzpah. . . was remarkable.

Working at a place like Grady oft times requires some well placed chutzpah. But whether you are a Grady doctor or not, just being grown demands that you occasionally man up--even if you're not a man. The hard part is deciding your personal limits.  Because sometimes, when you've reached yours, you just might have to hold up your hand, stand your ground and simply say, "hell no."

I have no idea if those folks made their flight. But I know one thing--next time I go to the airport, I'm getting there early.

***

Happy Wednesday.

Are you dancing like someone's watching?

Kindergarten me--who looks a lot like seventh grade me. Unfortunately.




"I just didn't learn anything new."

Those were the words that leaped from between those lines sent on my Annual Evaluation Summary from the residents I'd worked with last year. A summary that said scores of other things that were beyond flattering. Most of those words affirming what the seventh grade me longed to hear: "I like you. I really like you."

But these words rose up, mighty with teeth gnashing. I like you, yes. But I just didn't learn anything new. So funny that despite being perfectly couched inside words like "amazing role model" and "the best attending I've ever had" how much those words stung. Even though I have not completely separated myself from seventh grade me, I like to think that I have evolved.

But have I?

I remember putting on what I was certain was my coolest mini-dress and leg warmers for an after school dance. I took a deep breath and inched my way into the idle chatter of curvaceous cool girls, hands on their spreading hips, and shirts boasting the outlines of brassieres that, unlike me, they actually needed. One minute into it, I was blending in. Me, who had missed the puberty bus that they'd all boarded the year before and who was about as buxom as a kindergartner, was blending in just fine.

Run DMC pumped out of a tired speaker in our middle school cafeteria as bold tweens did popular dances named for pop culture icons in gender-segregated clusters. This day it was "The Smurf."

"Do you know how to do The Smurf?" one girl asked me, her braces glistening.

"Who me?" I asked, both happy and sad that I'd been noticed.

"Duh! Yeah you," she replied as she nodded her head to the beat while Run DMC repeated over and over "It's like that! And that's the way it is!" The others looked on, arms folded over those developing breasts that I so envied waiting for me to speak.

"Not really. . . Well, kind of," I finally admitted.

"You do?" Cool girl gleefully squealed. "Do it! Do it!"

"Yeah!" chided another, "We don't know how to do it! Do it!"

This did surprise me considering they all seemed to be very much in tune with the music and seemed like the types that would indeed know all of the latest dance moves. Could this, perchance, be my entry to the "cool girl" realm? And so. Against my better judgment . . . . . I did it. I did "The Smurf." With zeal.

Even though I could have sworn that someone was snickering, I decided that I was fitting in, so decided to ignore it. They were all clapping and smiling and sparkling with their braces, so I went for it even more.

"Go Kiiim! Go Kiiiiim!" they chanted.  I was over the moon.

"Hey Kim?" the main brace-faced one finally said, placing her hand on my shoulder and interrupting my groove. "Do you see that speaker over there?" She pointed.

I stopped and looked, smiling and panting. "Yeah, I see it."

"Okay, well how 'bout you go over and stand by it?"

And before I knew it, she nudged me in that direction casting me off like some sort of C list sailboat. Those sounds that seemed like snickers before had become full on unmistakable cackles. I was officially an outsider. I stood next to the speaker all by myself. . .feeling blue, just like a Smurf.

"'Cause it's like that! What? And that's the way it is!"

Sure, I had real friends back then who liked me for me. But damn, I wish I could go back to that day and just keep dancing with all of my might next to that speaker. For me, not them.

See? Back then, I just wanted to be liked. But that was when I was twelve. I'm a grown woman now, so it's different now, right?

I'd like to think so.

"I just didn't learn anything new."

Wow. Nothing new? Not a single new thing? See? I shouldn't have been bothered so much by that. But I was. I so was. Now let me be clear--I'm not the self deprecating type. I think my self image is positive enough to know that I have some strengths as a teacher. I also take formative comments seriously and look for ways to self improve. But today I can't help but take pause at how much those particular words sliced me to the white meat.

So I guess this started me wondering. . . .

Am I still that seventh grader doing The Smurf next to a static-filled speaker? In some ways, aren't we all?


Hmmm. Just wondering. . . . . weigh in, why don't you?

***

Happy Saturday to you (and your inner seventh grader.)

- Posted using BlogPress from my iPad

Thursday Top Ten: Hotel, Motel, Holiday Inn. . . .

Sorry this is tardy. . . .






Hey y'all!

I attended the American College of Physicians National Meeting in not-so-sunny San Diego. I attend this meeting every year, but it's the third time that I've been when San Diego hosted it.

Okay, so can I please just vent for two seconds?




San Diego! Your people are wonderful. Your hotels, lovely. And the convention center, superb. But WHAT is up with this craptacularly overcast and COLD weather you give us EVERY time we take planes, trains, and automobiles to your frickin' California coastal town? You mean to tell me I left Atlanta for this? The surf is so not up, dude.

Uggghhh!

Okay. Well since I am at the mercy of my iPhone and iPad, this week's top ten will be a random potpourri of this week's moments (since there is never a shortage!) I apologize in advance for the typos, grammatical errors, and randomness that will surely come from me being forced to use thumbs and touch screens to do this. . .

#10 The Swagger Wagon!

You guys already know about my not-so-secret desire to get a mini-van, one, because kids trash cars and two, because ever since I saw that lady hit the automatic doors on that rainy day in the carpool lane, it was a wrap.

Guess what? Since I was in Cali, I rented a swagger wagon! (See the post "Dirty Little Secret" 1/7/2011)

Yeah baby!





Okay.

(I was a wee bit disappointed that only standard issue rims were available.) Anyways. I want all the haters to know that I did get at least one "hey mama" look from a stranger. So don't. Hate.




Hey mama.


#9 Picasso-Pimptacular Pedi!

Since I flew into my hometown of Los Angeles (home of the world's most inexpensive pedicures), I HAD to get as much as I could drawn onto my toenails to prove it. . . .




Don't hate. This explosion of gaudy goodness was a mere $23 and took like TWO minutes! It's art, I tell you! Yes, I am somebody's mama's doctor--you got a problem with that?

#8. Pinkberry Yogurt!






And I also had to go to Pinkberry although Atlanta apparently has one now.


This I liken with the presence of more In'n'Out burger spots all over L.A. now. Something about making something easily accessible drops its cool factor a few more notches. For this reason, my Pinkberry tasted less luscious.

#7 Animated movie mayhem!


Those with kids under the age of six know how much it stinks when no animated movies are in theaters. Right now, there are like THREE or FOUR in theaters now!!! We kicked off our animania this week with "Hop."





No. It was no "Toy Story 3" but at least it wasn't in that highway robbery 3D that my kids refuse to wear those glasses through! I'd say it was worth a see. (If Russell Brand irritates you, however, you should definitely pass. . . )

#6 My "blind date!"

Well, sort of. How cool is that I had a lunchy-brunch with one of my favorite blogger buddies? So very. What a delight it was to chat it up in person with the witty author of www.smacksy.com. It sort of felt like I was meeting a celebrity, which felt weird while on the way to meet. But. When I got there it felt more like we were filming an episode of The Hills, The Grown Woman Years. (This version has pressed coffee in swanky bistros instead of martinis and Patron shots in deafening clubs.) Anywho. . . nothing about it was weird in the end, which was great. We yucked it up like old friends.

Officially not my blog-friend. Officially now my friend-friend. Now I totally want to meet some of my other fave blog-tacular virtual girlfriends. . . .

Verdict: Technology rocks. (Even if I've resisted the Facebook and Twitter revolutions.)

#5 Telling folks to talk to the hand.

This is me teaching a workshop at the ACP Meeting on steroid injection techniques. I love this ol' scary looking hand we demonstrate with!




Born to hand jive, baby!

#4 Wait. Huh?

Whilst shivering on a San Diego corner, I made THIS annoying little observation on my iPhone:








What's wrong with this picture? Ugggh.


#3 A slice of heaven.

Is it crazy that the highlight of my visit to San Diego was this "Heavenly Bed" in my hotel?

Ri. Dic. U. Lous.

Although I felt terribly guilty about being away from my husband and kids, I now officially believe that every mom should have periodic moments of losing yourself in a hotel bed with a remote and Showbiz Tonight. Not a romantic husband romp, either. Just you, a robe that you are contemplating boosting, and some room service. Oh, and some uninterrupted sleep.




Oh, the sleep? The sleep was on a whole 'notha level. Woo. Hoo.

#2. The Guilt.

Can I please tell y'all about the horrific rainstorm that hit Atlanta the night before I left for California? Oh my gosh! It knocked out the power at around 11:30 p.m. -- like two minutes after I put a WHOLE slew of the kids' clothes into the dryer.

The plan:

1. Stock fridge for Harry and kids while Mommy away.
2. Wash kids' clothes to make life easier while Mommy away.
3. Get gold star for being awesome team player.

Wha-had-happened:

1. Power went out at 11:30 p.m. on Monday.
2. After fridge had been stocked.
3. But before clothes got a chance to dry.
4. Power still out on Thursday, as in three days later.
5. All stocked fridge food is stinky.
6. All clothes scary and also stinky.
7. Kids subsequently stinky (until Dad checked into Holiday Inn last night.)

I was riddled with guilt in between Showbiz Tonight episodes and attending this meeting. Seriously. Will hear Harry lament about this week from hell from now until our 50th wedding anniversary. . . .

#1 This.





In the park last Sunday, Zachary said that this was for "double wishes." Please tell me you've seen a cuter sight so that I can tell you you're lying.

Wishing all of you "double wishes" this week and always. . . .

***

Happy Thursday. . . . .errr. . . . Friday.

Posted using BlogPress from my iPad

Keep feeling fascination.

*Random rambling ahead. . . .

Swaddling: Trust me, I'm a professional.

"Keep feeling fascination
Looking, learning . . . 

Moving on. . ."

~ Human League

___________________________________________

I have a not-so-startling confession to make:

I am a medicine nerd.

I know. . I know. . . some of you are gasping because of how ridiculously cool you perceive me to be. . . . .but alas, it is true.

Here's the deal: I love being a doctor. And not because I get to wear a long white coat or because it gets me the "proud eye" in the elevator from the Grady elders or even because I get to nonchalantly tell some one-uppity person in the park that this is my profession after some snoot-tacular remark is made despite their transparent attempts to sound non-obnoxious. Nope. It isn't even the excellent (albeit vastly variable) earning potential it offers or the privilege of putting "M.D." after your name on your checks (which I'm still not sure how I feel about. . .)

Wait. I had a point here. . . Oh yeah.

I love being a doctor for two simple reasons: people and medicine(in that order.)

Medicine just  excites me, especially when the diagnosis isn't known. (Picture me rubbing my dry-from-sanitizer hands together saying, "Bwah! Hah! Haaaaah!") Medicine nerds just love the hunt . . .asking those little questions that end up revealing some ginormous ah hah moment. Me? I call it "intellectually curious" My husband? He calls it "nosy"-- but either way. . . .there's just something about a fever of unknown origin, a nice red rash, and a randomly perplexing owie that just does it for me. Especially when it would otherwise be none of my business.

I was standing in the airport today and this woman had what I am certain was a thyroid nodule. At first she was talking on her phone and on a head turn I caught it. Shortly after, I was behind her in line at a food spot. Was it normal that it took everything in me not to reach around her and start palpating her neck? No. I'm serious. I almost. Grabbed. Her neck. And if she hadn't been in the middle of ordering a turkey, light on the mayo, on rye (good choice, by the way) I'm at least 75% sure that I would have made some lame attempt to bring it up in idle conversation.

"This pollen is awful, right? Matter of fact you have some pollen on the left side of your neck . . . Oh, my. . . that isn't pollen. . . It's a THYROID NODULE. . . You wouldn't mind if I just palpated that real quick. . . just swallow fir me. . . "

See? Not normal, I tell you.

THEN, I board my flight and this poor little baby is hollering bloody murder. But it sounds like an "I'm tired" cry, not an "I'm sick" or "I'm hungry" cry. The very young mother looked so mortified at the rude stares and eye rolls she got as we boarded that plane. See? This is when the mommy in me merges with the doctor in me. I wished so bad that I'd had some kind of doctor-y paraphernalia on so that I'd have a solid excuse for taking that (roughly six to eight week old) baby and swaddling him like an old school NICU nurse (the absolute one-two punch at that age I tell ya!)

Which reminds me:

What other person would sit in public places watching the motor skills and social interactions of children and subsequently quiz themselves on the kids' ages? It's nothing for me to be in the grocery store getting fresh produce while thinking: Okay. . . .transfers objects from hand to hand. . . Panicked when Mom bent over to get a grape off of the floor so no object permanence. . . .Hmmmmm. . . Then I just can't resist. . .

"Awww. . . .she's adorable! How old is she--like eight months?"

"No, almost ten months!"

I should've known something was wrong with me when the poor lady grabbed her baby and ran after I yelled out "Almost TEN months? Daaaaamn! Daaaaamn! Daaaaaaamn!" with my hands all thrown up. (Did I mention how much I like to be right?)

Not normal, I tell you.

I think this why I get all giddy when people at daycare ask me to peek at the goo coming from a kid's eyeball or why I accosted that poor unsuspecting woman in the supermarket when she was (just) trying to buy some Spam.  I maintain. It's not me. Its the medicine nerd in me.

Wait.

There are a couple of exceptions to my love for medicine. In general, I cringe at the following complaints: dizziness, back pain for the one-trillionth time that only responds to the most potent narcotic with the most potent street value, scary complaints from family members, and any time the answer to every single question about pain is met with clenched eyes and "Yaaaaaaaaaassssss."

Otherwise, I love medicine.

And the people. Oh, the people! Bring me your cantankerous and crotchety, your sweet and giggly, your belligerent and manipulative, and your obnoxiously know-it-all-y. I welcome your fearful, your suspicious, your fiercely spiritual and your firmly agnostic. I relish in pulling up a chair beside the most powerful VIP as well as the least of these. . . . the ones whose hard lives and strong stench keeps others at more than arm's reach.

I love the people the most because every one of them has a story and something to teach. I think that is the biggest perk about being a doctor. I get to sit at the feet of some masterful life lesson teachers. . . .every single day.

I'm glad that I am surrounded by scores of other "medicine nerds" which makes me not feel like such an outcast. Lovers of both people and medicine ---which, if you ask my biased opinion, are qualities inherent in the very best doctors.

My friend and fellow Grady doctor Stacy H. once said to someone when asked why she enjoyed being a (primary care) doctor: "I get to meet people one minute and hear the most intimate details of their lives the next minute. It's such an honor to be trusted like that."

Preach, sister.

I guess that's why I write this blog. Okay. . .partly because I'm nerdy in some other aspects of my life,too. . . but mostly because medicine, especially at a place like Grady Hospital, is a labor of love. I write because I want to remember as many details as I can and because, like a wise person (okay, Oprah) once said, "The love is in the details." Sure, for obvious reasons, things in these stories have to get modified. . . but not the message. I want others to share a piece of this journey . . .because some part of me believes that the best a place like Grady has to offer would move someone else and teach them, too.

Or at least get them reflecting.

It's been nearly a decade since I first started working at Grady and the novelty has yet to wear off. It gets tiring, yes. It gets heavy, sho' nuff. But the best part is that it just keeps getting better.

::sigh::

I heart this job. :)

****

Happy Tuesday.

- Posted using BlogPress from my iPad while on an air-o-plane in the SKY! Whaaat?! Whaat!!!

Boy. . .Genius!

Cows from the national ad campaign for chicken fast food giant "Chick-fil-A"

Fact: Doctors are competitive by nature. This is a necessary evil needed to get through med school. But. Just because you're competitive doesn't mean you have to be obnoxious.

Case in point:

One day I was tying Isaiah's shoe for him in the park. This random mom sitting on a nearby bench looks over and says to me in the world's most irritatingly one-uppity voice:


Her: "Oh, he doesn't tie his own shoes? How old is he, like five?"

Me: (giving her the world's HAIRIEST eyeball, especially because Isaiah heard her.)

Her: "This little guy has been tying his shoes and buckling himself in since he was barely four!"

(Points to her child prodigy who is sliding head first down the slide and two seconds from busting his head wide open.)

Me: (Fake-est smile ever) Oh. . . .well maybe next time I'll get him to tie my son's shoe."

Her: (Fake-est laugh ever while turning her back from the crazy lady.)

Okay. Now fast forward to this conversation I had with Isaiah in the car a couple of weeks ago:

Isaiah: "Hey Mom!"

Me: "Yes, Isaiah?"

Isaiah: "You want to hear something really, really funny?"

Me: "Definitely!"

Isaiah: (already snorting and giggling) "Okay, so you know how Chick-Fil-A is chicken?"

Me: "Yep. Yummy chicken."

Isaiah: "But you know, how actually even though it is chicken they always have those silly cows sneaking around?" (Love it when kids discover and overuse the word "actually.")

Me: "Umm. . . .yes, now that you mention it."

Isaiah: "Well. . . . it's because a cow is actually beef and actually they want you to 'eat more chicken' so they are plotting so you won't eat their beef! Isn't that funny Mommy?" (snorting, giggling, and totally beside himself.)

Me: (nodding my head with smug-proud-mama-my-child-is-so-a-genius smirk)

***

I WILL return to that park and find that snooty mom with her shoe-tying boy. And when I do (unless Harry is there, of course) I'm gonna walk up on her and circle around her, shoulders all up, hands all splayed and pointing with every third syllable, and eyes all crazy looking her up and down saying:


"What-what?!? CHICK-FIL-A, bay-beeee!! Unnnhhhhh!!!! What yo' son know about a COW being BEEF?!? Mmmm-hmmm!! I didn't THINK so! We ABSTRACT over here, boo! AB-STRACT. We tie together facts and string together ideas, ya FEEL me?!"


Okay.

Now that I think of it, that might get me arrested. But I was pretty proud of my son for that one. (Even if he can't tie his own shoe yet.)

By golly, the kid is learning something

***

Happy Sunday.

Beyond belief.

image credit

"One day I'll fly away

Leave your love to yesterday

What more can your love do for me?

When will love be through with me?

Why live life from dream to dream. . .

. . and dread the day that dreaming ends?"

~ "One Day I'll Fly Away"
lyrics by Will Jennings, music by Joe Sample

(now hearing this version on my mental iPod)

____________________________________________________________

My rounds were quiet and peaceful that day. The interns had the day off, and the resident was putting out fires on other floors. This time for you would not be divided by medical student queries or carefully guided tours of your physical findings (with your permission of course.) I was all yours that day.

It was a weekend day, so there weren't even any meetings to race over to be late to or conference calls to dial into or students shuffling their feet in front of my office door or urgent emails to return. The kids were somewhere climbing jungle gyms or splashing in puddles or licking syrup off of their hands with their dad who had kindly sent a text that simply said, "We're fine." So that meant that, on this day, I was all yours.

This day, I saw you in morning light so bright that it made me take pause. Despite the overcast sky and its imminent plans to deliver a torrential downpour, somehow the rays that were stubborn enough to come out any way managed to find you. Your hands were idle, folded over your abdomen; your eyes tired and fearful. It had been a rough night; the pain had been at almost a 'ten' until finally you told someone and ultimately received a higher dose of pain medication.

"I hate to be a bother," you tell me.

"But you aren't a bother," I quickly reply. "If you are in pain, I have failed you."

"Okay." Your face washes over with a blanket of childlike comfort, but not your eyes. I can still see fear. Cancer is something to be afraid of. Especially this one.

I glance over at the window sill. Not a single card or flower. No photos of you posing with loved ones during the honeymoon that preceded this diagnosis and no worried significant other abruptly rising from the bedside chair upon my approach to examine you. It was just you. And today, just me.

"Are you? In pain, I mean?"

"No. I am okay."

"Good."

I carefully pull back your cover and examine your cachectic body. My stethoscope rocking over your ribs; their perfect outlines like some kind of skeletal relief sculpture. Your lungs sound surprisingly clear on this day, and outside of the mild tenderness around your feeding tube, your sunken abdomen is equally unremarkable. I inspect your legs for any asymmetry; your backside for redness from the pressure of lying in bed more than standing up and making it.


No, your exam is not normal. But for this day, it looks pretty close. With the exception of your fearful eyes, it is normal enough to plan your discharge.

"There is so much to coordinate," I say softly. "Our plan will be to get all of this done for you and discharge you first thing in the morning. How does that sound?"

"That sounds good."

"What questions do you have for me?"

Your smile is warm and genuine. Your bony cheeks and wasted temples perfectly framing your every expression. "I think you answered them all."

I reach down and put my hand on your soft cheek. "Are you sure? Is there anything you need?"

You smile again and shake your head. "I'm okay."

"Okay."

I step back from the bed and delicately arrange the covers over your tiny shoulders. I fluff the pillow and tuck another blanket around your neck; enveloping you in as much safety as I can.

"I'll see you later, okay?" I say after finishing my fuss over the bed.

You nod and smile once more.

I walk away from your bed and that morning light. . . . around the thick pink curtain dividing it from the other side of the room where the neighboring bed was empty. Suddenly, I abruptly stop in my tracks. The next thought I continue to replay because it was so memorable. It was simple and clear--like the single chime of a tiny bell--and enough to halt me in place:

Maybe I should go and just sit with you. And hold your hand and maybe even. . . . pray with you. Or better yet just be with you a little longer.

The Grady elders might call this "The Lord puttin' something on your heart." And they call listening to such a thing "being obedient." Others might call it something else or even be uncomfortable thinking about it. Regardless of what you call it, it was something. Something strong yet fleeting that I somehow allowed to come and then go in the blink of an eye.

I lean back around the curtain and into your light again.

"Ma'am?"

You raise eyebrows and turn in my direction.

"Umm. . . you. . . make sure you remember what I said about the pain medicine, okay?"

"I will," you murmur quietly. "I will."

And with that. . . . I leave. Thinking I can do it tomorrow. Letting go of that moment in time on my solitary rounds.


Early the next morning, the intern covering the team on call left a message on my voicemail. You were found pulseless. They worked on you as hard as they could to bring you back. But unfortunately, they could not.

No! I must be hearing wrong!

I remembered your pleading eyes and those words put on my heart. I replayed the message and immediately felt my pulse quickening and my eyes welling.

No! It wasn't time yet!

But actually, it was. That morning, I stood listless in a hot shower crying and crying. Not because I could have saved you. And not because I could have cured you, either. But because I didn't listen. And regardless of what you believe or who you pray or don't pray to, sometimes you get a little nudge that tries to give you a message. This time, your eyes tried to tell me. And even after your eyes tried, something else tried, too. But I missed my cue.

Now I know. That day, I was supposed to be the cards on your window sill and the flowers on your tray. And even though you weren't in pain, in a way I did fail you. I should have yielded to that tug, that magnetic force that was pulling me back to you. And I'm sorry. I'm so, so sorry I didn't.

But.

Today, I will dry my eyes and honor you. And for you, I will never ignore that whisper laid upon my heart again. Because that time was your time. And on that day it was just you and just me. So next time, for you, I will be obedient.

***