Top Ten: Andy Rooney-isms.

Andy Rooney of 60 Minutes

Andy Rooney's final broadcast was shown on CBS' 60 Minutes last Sunday. The curmudgeonly king of the random observation and the guy who, if you ask me, is the original blogger, made his living by simply speaking his mind. Matter of fact, Jerry Seinfeld should probably credit ol' Andy for giving him the idea to make a show about nothing. Because Andy Rooney taught us that talking about nothing is really something. Imagine that.

Paying homage to the great Andy Rooney, I bring you this week's top ten. . . .which is nothing but my random questions, observations and thoughts about things going on around me. Or as my classmate in med school used to say, "A whole bunch of nothin'."

I added Mr. Rooney's final segment at the end of this post. This really speaks to my thoughts as a writer. It's hard to believe he is 92 years old. Take a moment if you can to watch it--especially if you do anything creative. I bet you his message will resonate with you, too.

Thanks for showing us how to do it, Mr. Rooney. (And we promise not to bother you in public should we run into you.)

*By the way, this post was inspired by my dad who turns 68 today. He's always been a huge fan of Rooney and was the one who turned me onto the segment back in the day. Happy Birthday, Poopdeck!


***

#10 No Pundit Intended.

Pundit. The pundits said this and the pundits did that. Pundits. Pundits? This word is one I don't get. I always have to look it up. Turns out that it means "authority or expert" on some topic that "shares their opinion with the masses through media, etc." Every time I hear this word I feel like it's unnecessary. Kind of like "insurgents." Seriously.

#9 Show me the money

What is UP with little kids and money? My children have recently taken to liking money. Why? I do not know. I mean. . .I am a poor righteous teacher in a public hospital so LORD KNOWS they aren't getting it from me.

They find it on the floor of my car, in the couch cushions, and on our nightstands and seriously? They hoard it. Like for real. Is this a phase? I am told it is. Especially Zachary. And he's not even five!

My kids don't buy things yet. They can count money but other than that they just like having it. It slightly disturbs me. Tell me this is a phase.

What's that about?


#8 Taking turns.

What is the deal with four year old amoeba soccer? This is where eight four year-olds run in a giant pack after the soccer ball for one hour while the parents sit there clapping all giddy-like. There is this crazy culture where you cheer and clap for everything that every person does, even if it includes picking their nose or pulling out a wedgie while someone flies by them with the ball. Hold up. Tell me, y'all. At what point do we get to stop cheering for the opposing team? And what is REALLY up with somebody telling the kids to "hold off for a minute" so somebody could have a turn at getting a goal? Get a turn?

0_o


Aww hell naw! Today they rolled the ball dang near into the goal for the other team. But here's the problem. Zachary and another kid on his team have older sibs. They've been watching and waiting, and begging "put me in coach!" So now that they're in? Oh baby, they're in. And in it to win it. No amoeba soccer for them.

So yeah. They roll the ball right at the goal in front of this kid on the other team who'd been blowing spit bubbles and making grass angels. She was supposed to make a goal. I mean, it was her turn and all. But Zachary missed that memo and promptly bent it just like Beckham, kicking that sucker right over her head. Directly to his teammate who got his full Pele on--- scoring for the white team!


Yeaaaaaahhhh Babbbeeeeeeee!!!!!!

Yes, Harry and I are the obnoxious parents cheering waaaay too loud for this to be 4 year old soccer.

(Is it normal that they're only four but they were doing the backwards victory jog complete with a high five while setting up for the next ball?)

Hmmph. Whaaaat-ever.

#7 Crumbsnatchers.

Here is something fascinating I learned at work. I discovered that there is this universal dictionary/wikipedia that black folks are privy to. It includes (for those over thirty-five) the lyrics to "Rapper's Delight", "La Di Da Di", and all of the songs in the movie "Sparkle." (If you have no idea what I'm talking about, this can only mean one thing--you are not a thirty-plus year-old black person born and raised by black people in the U.S. ) Now those things I just named are generation-specific. But some things? It doesn't matter how old you are or young you are--if you're black, you'll know it.

Case in point: "Crumbsnatcher." The universal dictionary also includes the word "crumbsnatcher." I mentioned this in clinic to someone who had no idea what I was talking about. "You know, crumbsnatcher!" I said. I couldn't believe it. Everyone knows what a crumbsnatcher is. Well, apparently not.

I asked some black folks in and around the clinic--100% knew exactly what I meant. In fact, I have yet to meet any sho nuff and bona fide African-American person who hasn't heard and used this word. Do you know I asked nearly thirty non-black folks if they knew what a "crumbsnatcher" was and they all said no?

Wait, I take that back. One person said, "Isn't it that thing they use in restaurants to clear the table?"

And I was like, "Uuuuh, that would be a crumb-CATCHER."

0_0

Okay. If you are black, you already know what a crumbsnatcher is. I would love to hear your two cents. But for real? Somebody non-black please (without using urban dictionary) prove this theory wrong by telling me you'd know how to use "crumbsnatcher" in a sentence. . . . .

Come on. . . .what you got?

Disclaimer:  Non-black people who are married to an African-American person or who have worked at Grady for more than fifteen years are disqualified.  Conversely, black people over thirty-five who have never heard of the movies "Sparkle", "Mahogany", or who have never had their hair braided on a porch are also disqualified as well as questionable--unless they can answer yes to the question below.*

*Did your daddy have one of these parked in his hair while barbecue-ing on one of those half barrel trashcan grills during your upbringing? Okay, then you get an automatic reactivation of your membership card as this trumps all of the aforementioned.

#6 Expecting the Unexpected

What the heck is up with people asking people if they are pregnant? What the. . . .?

One of my friends (who is NOT pregnant) was asked if she was pregnant by one of the nurses last week. This woman is NOT overweight and she does NOT look pregnant! But any of us who are thirty and up know that if you aren't properly focusing on your abs, any one of us can be one exhalation away from looking three months preggers.

New rule: Unless you see the BABY CROWNING, don't ask. Matter of fact? Don't ask then either.


#5 No shame in the game.

If you eat McDonald's and smoke Marlboro's, do you carry your Marlboro's in your front pocket and eat your Mickey Dee's in the clinic room while waiting for your doctor?

Damn.


#4 Problem solved.

"Doctor, when I take my finger and press it real, real hard right here, it hurts really, really bad."

"What made you press there real, real hard in the first place?"

"I 'on't know. I just did one day. And it hurt really, really bad.

"Alright. So here's what I want you to do. Don't press there. And if you must, just don't do it real, real hard."

"Okay then, doc."

(Thank you very muuuuch! I'll be here all week.)

#3 Bad ass.

Harry and I were at Fellini's Pizza with the kids on Friday. There was this little boy running all over the spot and climbing up on the booths. He eventually climbed up onto the narrow strip at the top of the bench between two booths. Standing. Up there. Treacherously teetering on this wooden seat back and scaring us all to death while his parents laughed and ate pizza.

Harry looks over at me and says, "Now, tell me what happens when that little bad ass boy falls on his head?"


*WHAM!*

Wait no more, Harry.

#2 Port-a-party

What is it about little kids needing to use port-a-potties? Today we were at soccer and Zachary, of course, announces that he has to go to the potty. But he says it with a straight face and without the dance so I froze in terror.

I held up my fingers-- l or V? (one or two)

Two fingers. "Boo-boo, Mommy. I need to go boo-boo!"

L--awd. *wretching*  (sorry, just threw up in my mouth a little bit.)

Please. Tell me what in the entire world is grosser than a.) taking your kid to a port-a-potty, b.) hoisting them into the air so their bottom doesn't touch the port-a-potty, and c.) the sound of number two plunging three feet downward into the big sea of port-a-sewage? Answer: NOTHING.

(thump)

Me fainting at the thought of it. Eeeeew. Ewww. Eeeeew!!

#1 Hey Kool-Aid!

On the Grady elevator last week. A baby starts crying and her mama tells who appears to be her friend this:

"Reach in that bag and hand me that bottle with that red Kool Aid in it."

0_0

Friend does not flinch and hands said Kool-Aid bottle to the baby. Who, of course, laps it up.

"She like that Kool-Aid!" friend exclaims.

"Yeah, girl. That's all she ever wants."

0_o

I was swerving out of my lane so bad it was unreal. I tried. I tried so hard to mind my own business. But I did this thing Harry really can't stand--where I start with the b.s. question to open the door to get to what I really want to say.

"How old his she?" I asked.

"She nine months."

"First baby?" I continue.

"Yes, ma'am."

As Harry would say, Here we go.

"Oh . . .okay. Well. . .be careful with that Kool-Aid. It has a lot of sugar in it, you know. And at nine months, all you need to really give her is either formula, breast milk or water to drink."

I could see Harry shaking his head now.

"I don't put all that sugar up in my Kool-Aid like some people do. I always use the measuring cup and only put in one cup."

>_<

"Okay, then. She's a really cute baby."

Back to my lane.

***


Bonus one:

Awww, ma'am!

This young guy is walking over the bridge from the med school in front of me last week. He keeps looking back at me and walking, like he knew me. He appeared to be a student somewhere at Emory and he was of color, but I didn't recognize him at all. Finally at the end of the bridge, he looks back at me and speaks.

"Excuse me, ma'am? Ma'am, I just had to tell you-- you are absolutely stunning. That's all I wanted to say. You're just. . . . a really striking woman, ma'am."

I kind of blushed and mumbled a thank you. And added a little pep to my swagga-docious step.

Then, a few moments later, I replayed that whole thing to myself.

• three "ma'ams"
• one "stunning"
• one woman
• one "striking"

Hmmm.

What does this mean? I am thinking this means I was like a hot mom. (Not to be confused with a "hot mama.") Which I am unsure how to feel about. Oh well. At least he didn't call me "jazzy"--which is Harry's term for older women who were probably, and I quote, "really hot back in the day." 

*sigh*


***

Check out Andy's final "last word" below.

Stay hungry. Stay foolish.

Steve Jobs, Revolutionary and Dreamer 1955 - 2011

"Your time is limited, so don't waste it living someone else's life. 

Don't be trapped by dogma 
which is living with the results of other people's thinking.

 Don't let the noise of others' opinions 
drown out your own inner voice.

And most important, have the courage 
to follow your heart and intuition. 

They somehow already know 
what you truly want to become. 
Everything else is secondary."


~ Steve Jobs, Stanford Commencement Address 2005

Now that's what I'm talking about. This man never even graduated from college.  He was a tremendous success but credits it all to being "hungry" during some of his biggest failures.  Steve Jobs, the creative mind behind Apple Computers and Pixar Animation died today at the age of 56.  He lost his life to pancreatic cancer. 

Today I'm reflecting on what happens when people dream and live out their passion. I am inspired by Steve Jobs' story and his life.  As I type onto this MacBook Pro, check for comments on this iPhone that will likely get replaced this month with the newer version, and finish reading a piece of fiction on my iPad tonight, I am marveling at the power of what one imagination, when combined with the enthusiasm, support, and elbow grease of others, can do.  

Oh and what's up with this font, you ask? Well. . .we have him to thank for cool fonts like this italic one. Who knew that a calligraphy class he took back in the day would lead to this? You never know how something will help you later. . . .

"When I was 17, I read a quote that went something like: 'If you live each day as if it

was your last, someday you'll most certainly be right.' It made an impression on me,

and since then, for the past 33 years, I've looked in the mirror every morning and

asked myself: 'If today were the last day of my life, would I want to do what I am

about to do today?' And whenever the answer has been 'No' for too many days in a

row, I know I need to change something."

Alright. So what are you doing? Are you living your life or someone else' life? What's your intuition telling you? What's that inner voice saying? Well???

Time is limited. . . .choose carefully.

Rest in peace, Steve Jobs. And heartfelt prayers for those you leave behind.

***

"Stay Hungry. Stay Foolish." Steve Jobs' message in 2005 that is as good a word as any I've heard in any church. Check it out and be inspired.

**P.S.  Nate G., you channel Jobs' spirit in so many ways. Stay hungry . . .stay foolish. . . . you inspire me, too. You so very do.***

And now playing on my mental iPod. . . . .as I think of a revolutionary mind. You say you want a revolution? Then get crackin' on your dream!

This makes me cry.

"You is kind. You is smart. You is important."

~ Kathryn Stockett, The Help

I called my dad in California the other day and simply said, "Dad? I need you. I need your influence and your help and your everything today. And I really wish you lived here. Today, I really, really do."

And then I got off of the phone because I had a meeting and didn't want to start crying. He said a few words back to me and let me go.


I cried anyway.

No. There was no catastrophe. Not at all. It was just one of those days. I just wished that he could be sitting at the kitchen table with Isaiah like he did with me way back when. See, my dad and my mom? They are just hard-wired for making kids feel good about themselves. Particularly when it comes to school. Mom is just north of Atlanta, so we get her influence abundantly and often. But when combined with Papa? It's the one-two punch.


I think I'm a good mother. I do. I love my kids and love my husband and work hard to let them know each day how cherished they are. But mothering isn't always a cake walk and I am coming to deeply respect all that my parents did with the four of us. All that they poured into making us hard workers and bright, inquisitive human beings. It isn't always easy. Or intuitive. I'm seeing that first hand.


On that day, I just wished I could have my Dad's influence. The man in him, the wisdom in him . . . the deep of his voice and that special thing God equipped him with for dealing with children. No, not just the influence that trickles over from me since I was raised by him . . . . but his daily influence on my child.

You know? It's funny. There's something in my father's presence that makes kids want to work harder and sit up a little straighter. Firm but loving. Encouraging but expectant. I've not fully captured it in words, but this is probably one of the main reasons I send my children to California each summer to be with him. I'm fortunate to be married to a man who also values this. I want them to have a big dose of that presence while it is here. Because it meant everything to me.

And it still does.

"I need you, Dad."

"I'm here." That's all Dad said. And then he got off of the phone.

My friend Angella L. has a special knack for capturing ordinary yet special family moments in simple photographs. Ever since I met her, I've tried to do more of that. This picture was taken at my kitchen table this evening. Isaiah and Papa practicing spelling words and math problems over Skype. Skype. Dad infusing that special ingredient of his into my manchild and my Isaiah sitting a little taller and working a little harder because of it. Exactly what I was wishing for. And it was Dad's idea.


This? This image will make me cry for the rest of my life. One, because I know that parents don't live forever and two, because parents aren't always as "into" the grandparenting thing as this. I'm so thankful! I realize that this is a blessing. I so, so do. All of it. Having parents and grandparents and having them willing and able and selfless enough to participate in your life in such tangible ways. Mom volunteers once a week at the boys' school and does the same at the school my brother's children attend. And Dad? He does things like this.

Yes. We are blessed.

Look at this picture. This explains who I am. This is my mother. This is my father. This is my family. This is "I'm here."

This is who I am.

I am kind. I am smart. I am important.

Yeah.

***

Manscaping and highbrowisms.

*Warning:  100% non-medical post ahead. Proceed with caution.

The last few weeks have been pretty crazy. Crazy, do you hear me?  Craziness at home, craziness at work, craziness all over the place. Whenever my life gets crazy, some of those quasi-important-to-me-but-not-really-important-in-the-grand-scheme-of-things items get placed squarely on the back burner. They bubble and overflow and sometimes even scorch on the bottom. But when life gets too crazy, that's just the way it has to be.

What things qualify? Oh lots of things.  But one in particular that I have really let get out of hand during these past few weeks was eyebrow grooming. Yeah, I said it. Eyebrow grooming.

So. In the craziness of all this craziness,  my brows started looking a little something like this:

What you know about Andy Rooney and 60 minutes?

Okay, okay.  Maybe not quite as bad as ol' Andy Rooney's are, but you get the idea. Anyways.  As some of you may remember, thanks to one of my greatest Grady adventures of all time, I have this amazing place I go to here in Atlanta for eyebrow grooming. It's this place that uses thread to neatly shape your brows to natural-but-not-Curious-George-looking perfection.  And if you don't know the story behind me and the eyebrow threaders at Hair Images, if you have absolutely nothing important to do with your time, read this.

Now. I know somebody somewhere is reading this thinking--really? Eyebrow grooming? What could be more unimportant? Oh, and someone else who is new to this blog is like, "Wait--I thought when so-and-so told me to check out this blog she said it was about medicine and other medical coolness?"

First, I'll say that--yes, eyebrows are not exactly life-or-death. But for whatever reason, up until I met the Karate Kid, I had been in hot pursuit of the perfect eyebrow groomers. And the key to the perfect eyebrow groomer is one that makes you look neat and natural but not surprised.

Hello?  You still with me?  Good.

Okay. As for the new person reading this blog, sigh. . . .okay.  I may as well come clean and let you know that while a good deal of the material found on this blog is medical-adventure related, a fair amount isn't at all. But in my defense. . . .I think life and all of the observations we make in it go together like a big tossed salad. Like, noticing something in the grocery store or the hair salon isn't that different from doing a double take in the hospital during a physical exam.  

Uhhhh, okay. Where was I?  Oh! Eyebrows.  Okay, so finally on Friday, I get some free time to tend to eyebrow grooming. I grab my Nook e-reader and head over to Hair Images for a walk-in appointment.

Now let me tell you--this place stays packed.  It used to be the well-kept secret of all of the gorgeous Indian and Pakistani girls in Atlanta, but eventually everyone else caught on. (All of my Indian and Pakistani sisters are nodding right now going, Mmmmm hmmm!)  Even if you have an appointment, the wait is bananas, so you have to come ready to be patient.

What's made it even worse, though, is that NOW it isn't just the dreadlocked sistas and the blonde sorority girls getting in on the act. Now there's DUDES up in the spot, too. Yes. Dudes.  And not just the androgynous types or the Ru Paul types, either. I've seen the most regular-looking joe hunched over with elbows resting on wide open knees and thumbing through magazines. Periodically looking up and wanting to yell out, "Hey! I got next!"

Confused, are you?  Let me let you in on a little secret.   . . . .shhhhh. . . . they call it. . .wait for it. . . .ah hem. . . .

Manscaping.  (Sorry. Just threw up in my mouth a little bit.)

Yeah. Manscaping.  Shaping up those renegade eyebrows and sometimes even waxing ears. No. I ain't kidding.

Now before you even ask--the answer is NO. The B.H.E.  is not a manscaper, but I can honestly say that if Harry did have a monobrow, I doubt that he wouldn't at least consider it.

Okay, so I'm telling you ALL OF THAT to tell you about what happened when I was getting my brows done Friday.  I walk in and the lady I usually see isn't there. I've been coming long enough to know who is the next best thing, and who to avoid. So I survey the situation. There's the new lady who seems hit or miss, the lady who used to do my brows but who I really think needs reading glasses because she kept leaving big holes in my brows and then there's the lady that has the station next to my lady who does a really decent job. I sign up for the lady-next-to-my-lady and took my seat to wait.

But wait--there's more!

Right beside HER is this other woman who I did try once when my lady (and the backup lady) were gone. She left my eyebrows so thin that I looked ten years older (and like a black version of Pamela Anderson's scary brows.)

Anyways. I call her the butcher-brow lady and have waited a full extra 45 minutes to avoid her. And everyone she does gets the thin treatment. Lucky for her, some folks seem to like that Pamela Anderson-just-got-electrocuted-Curious George look so she gets her share of clientele. Good for her.

Anyways.

So check it. I'm reading my Nook e-reader and minding my business when this hyper-masculine yet hyper-hairy dude comes in and sits beside me in the waiting area. I glance over and notice that he definitely has the unibrow thing going on so he's in the right place. He was good looking, too. I know I'm married and all, but I can still say that this guy was pretty easy on the ol' eyeballs--unibrow and all. I couldn't place his ethnicity. . . .Persian or Armenian or Sicilian? I wasn't sure.  He was wearing some kind of keg party frat shirt and looked a little uncomfortable with all of the estrogen in the room.  But, baby?  That unibrow needed attention--he wasn't going anywhere.

Okay, so y'all! You know what happened next. Of course you do!

Like this, but less shmancy

Now, the way this spot is set up is basically with five chairs on the right and five on the left. Everyone waiting can see everything that's going on (with the exception of these private rooms where allegedly the waxing goes on.) Anyways. . .So lady-next-to-my-lady calls me and I go to her chair. I'm laying in my seat with my chin tilted up ready to get my eyebrow groom on.

That's when it happened. Yes, it did. The butcher-brow lady calls Frat dude!  It was like she called his name in slow motion. . . . .

"F---r---aaaaaa-----ttt D--oooooooo-d!" (insert vacuous echo here)

Gasp! I almost sat up in my seat when I heard her call him; I felt like it was my civic duty to warn him that this woman does not believe in "cleaning up the strays" and "shaping things up."  Lady-next-to-my-lady freezes and gives me the hairy eyeball (no pun intended.)  I settle back down and (literally) start praying for Frat boy's siamese brows after deciding that jumping in front of butcher-brow lady's chair would be inappropriate.

Lord, please don't let her over thread him. Please don't let her overpluck him.

I strain and hear him mutter a few lines about "just make them look neater" and "you know, the middle part."  She cheerily obliges.  I narrow my eyes and curl my lips because that's exactly what she said to me before she had me looking like a seventy year old woman. Poor Frat boy. I continued my prayer.

Lord, for real. Don't let her butcher his brows, okay? I mean, if that's Your will and all.

So, I lay there until my eyebrows are done. I sit up and look in the mirror. Not as good as my-lady but it's the next best thing and waaaay better than when I got there.  As she hands me my ticket, from the corner of my eye I see butcher-brow lady handing Frat dude the hand mirror. What happened next scratched the needle all the way across the record. I heard him growl under his breath--but not so low that nosy me couldn't hear him:

"What the f%#@!?!?"

I swung my head in his direction and saw what the expletive was about. And boy was it warranted.

OM-expletive-G. This was a disaster. His brows were--as my friend David calls it-- "all the way snatched!" 

Okay, so obviously God had bigger things to deal with because that prayer didn't EVEN get answered in my favor. Well. . . on second thought. . . maybe I should have been more specific. Frat dude's eyebrows weren't nearly as bad my Pam Anderson-scary-Curious-George disaster of 2009. . . in fact they were lovely. . . .had he been a woman.  Perfectly arched and perfectly groomed. But too perfect for a dude's dude. Overly intentional in their appearance, in their exquisite precision, and the absolute antithesis of what a dude wants in his manscape.  

"I can fix it," she said to him.  And I was thinking exactly what he said next.

"Fix it?!?"  

Awww hells nawww! 

Dang. Frat boy looked like he was going to cry up in there. And you know? He had good reason to. Those brows were a hot mess. For real. I mean the dude looked. . . .well. . .the dude looked like a lady.  Poor Frat dude. Poor, poor Frat dude. I felt so bad. Like I should have stopped him, but I was trying (for once) to watch my own lane.

To make matters worse, his girlfriend or whatever she was walks in as he is paying at the counter. She stands there studying his face as his face grows redder and redder.  Finally, she can't take it.

"Dude.  Your eyebrows look. . . .oh my gosh, dude."

She snickered a bit and covered her mouth realizing when she saw him looking tearful that this was not a good thing to say.  And out they walked. Her staring at him with her hands over her mouth and him sulking out like he'd just been branded on the cheek with the scarlet letters PTDQ (for part-time drag queen.)

Wow.

I still feel kind of bad, y'all. Should I have stopped him or was it none of my business? And is it awful that I wish I'd gotten a picture of his brows and that I couldn't wait to blog about it? Awful, I know.

See? These are the important things I have to think of when I get some time off from Grady.

***
Happy Sunday, y'all. 

P.S.  Harry insists that I did not do my civic duty and that I should have intervened. But I'm saying--what was I supposed to do? Say it right in front of butcher-brow lady?  He laughed so hard that I thought he would be sick and kept saying, "Babe, you're dead wrong! You're supposed to help people--you're a doctor!"  (And then he laughs louder and harder.)

Hmm. I guess.

***

The Last Leaf Has Fallen.

J. Willis Hurst, MD  

(Sunrise 1920 ~ Sunset 2011)

Today is a sad day for the medical community and especially at Emory.  After a long life and influential career of caring for patients and teaching us how to do the same, the iconic clinician-teacher, Dr. J. Willis Hurst, has passed away.  

As a teaching internist at Emory, I am proud to be among those who carry on his ideas and remember his influence as we teach the residents in the very Internal Medicine program named for him--The J. Willis Hurst Internal Medicine Residency Program. I feel fortunate to have been at Emory during his time on faculty, and even more fortunate to help carry the torch that he worked so hard to keep lit in us all.

This morning I am quietly reflecting on Dr. Hurst and his legacy in patient-centered care and medical education. I am sharing a few of his own words, followed by some quotes that he personally found influential. 

"The truth has always been difficult to identify.
Unfortunately, there is every reason to believe that
the future identification of the truth will be even
more difficult than it has been in the past. This is
because there are currently more nonscientific
forces that clutter the mind than there have been in
the past. There is also evidence that such forces will
be accelerated in the future. Accordingly, the identification
of the truth is destined to become the
physician’s greatest problem."

~ J. Willis Hurst

***

A few of his favorites:

"I am a part of all that I have met."

~ Alfred Lord Tennyson, 1842

***

"We may affirm absolutely that nothing great in
the world has been accomplished without passion."

~ Georg Wilhelm Friedrich Hegel, 1832

 ***

"Be not the first to whom the new are tried,
Nor yet the last to lay the old aside."

~ Alexander Pope, 1711

*** 

"Your compassion for your patients—trying
to do the best for them—must be the major motivating
force in your effort to remain competent."

~ Dwight C. McGoon

***

"Press on; nothing in the world can take the place
of persistence. 

Talent will not; nothing is more common
than unsuccessful individuals with talent. 

Genius will not; 

unrewarded genius is almost a proverb.
Education will not; 

the world is full of educated derelicts. 

Persistence and determination alone are
omnipotent."

~ President Calvin Coolidge

***

"Like love, talent is useful only in its expenditure,
and it is never exhausted."

~ E.P. Tuttle, Sr.

***

"Clay lies still, but blood’s a rover;
Breath’s a ware that will not keep.
Up, lad: when the journey’s over
There’ll be time enough to sleep."

~ Alfred Edward Housman, 1896

***

Rest in peace, sir. And rest knowing that your legacy never will.

***

Hurst, JW. Quotations on the Wall. Annals of Internal Medicine. 1999;131:551-554.

Blessed insurance.

"Blessed insurance

Health care is mine

Oh what a foretaste

of co-pays divine!

Not much selection

purchased by y'all

Flexible spending

no referrals . . ."

~ lyrics adapted by yours truly

(Thank you very muuuuch! I'll be here all week!)

 ____________________________________________________

"If I get in a car accident take me to Grady."

That's the catchy slogan that was printed onto a big stack of bumper stickers a few years ago.  Pull into the parking garage at Grady, and you'll still see at least five of them before you even get to the third level. Some slapped on the backs of fancy vehicles even--waving that proud flag that says, "I heart Grady."

Well. . . sort of.

Like a lot of county hospitals in major metropolitan areas, Grady is your go-to when it comes to trauma. If you're bleeding, burning, got road rash after someone had road rage, got your rear end smashed by a drunk driver or even by a sober texter--ask anyone in Atlanta and they'll tell you: Go to Grady. No question.

But what about when it isn't a car wreck or a surgical emergency? What about when it's something totally not trauma-induced like pneumonia or a urinary tract infection?

Recently, I cared for this patient who got me thinking about this question. I can't go into detail on the specifics with that actual patient. But here is an adapted story that underscores what we faced that day.

Oh. And details here are dramatically changed, are an amalgamation of true events, or are completely made up. The point, however, is the same.

Mr. Ingle

Mr. Ingle was this gentleman who'd been brought to Grady after calling 911 for a severe headache he had while spending time with friends one evening. Although he was an Atlanta native, Mr. Ingle didn't live here any more. He had a fine job as a Nashville executive and was back in his hometown for a business conference.

On this particular evening, he had slipped away from his Buckhead hotel to hit a cocktail party hosted by an old friend. One minute they were laughing, reminiscing and enjoying a few martinis on the swanky backyard deck. Commenting on the Atlanta skyline and how breathtaking it appeared from this regentrified downtown neighborhood. Clinking frosted art-deco-y glasses filled to the brim with overpriced vodkas. The next minute he was writhing around in pain on an ultrasuede chaise lounge; squeezing his right temple and asking someone to call 911.

"It's the worst headache of my life," he told the EMT when he arrived. Tears were rolling from his eyes and he rocked back and forth on the edge of his seat.

That kicked things into high gear. This could be serious. As in you-might-die-if-we-don't-hurry-up serious. Rushed him to the nearest hospital which, from this Grant Park locale, meant one thing and one thing only: Grady Memorial Hospital.

Oh, just Grady.

"Grady?"  asked one of his friends. "Yikes! Do we have to go there? He has Aetna, you know."

That EMT didn't even bother to answer. He slammed the door shut and whisked Mr. Ingle away. Him and his Aetna. 

A young man who was previously healthy now has the "worst headache of his life?" The ER team heard this story and leaped into action. IV in, CT scanner hot and ready, and lumbar puncture good to go-- all within moments of hitting the door.  This was a subarachnoid hemorrhage (read: a life-threatening brain bleed) until proven otherwise. This requires everyone to move fast because time is brain. Period.

Head scanned. No evidence of bleeding.

Hmm.

Lumbar puncture obtained.  Again, no evidence of blood.

Hmmm again.

The spinal fluid came back from the lab and it had 55 white blood cells in it.  55. Not high. Not normal.

Uhh, okay. What does that mean?

His blood pressure was high, too--that, plus this entire scary headache scenario got him admitted to the Internal Medicine service, which is where we came into the picture.

But here's the thing. This patient didn't exactly fit your standard indigent patient care setting demographic. His friend had tried to clue the EMTs in on that but they weren't having it. But the minute his sister arrived at the hospital, she was determined to make this crystal clear.

"Um, I'm not sure who we need to talk to about getting him transferred to another hospital, but that needs to happen."  His sister stared straight into the eyes of my intern and told her this point blank. She gripped the handle of her designer handbag with one hand and nervously rubbed the end of her sleek pony tail with the other. "I think there's been some mistake. He has insurance."

"Yes, ma'am," answered the intern, "we actually do care for some patients who have insurance."

"That's good. But this isn't where we prefer for him to be. How do we proceed?"

And my intern didn't know what to do.  Fortunately, the senior resident standing beside her had a few ideas of what to say. "Well, ma'am. Right now we're trying to sort out what's going on with your brother. We can't transfer him, but I can assure you that the same doctors who work here at Grady are the ones that work at Emory Hospital. Like, for example, I work at both places."

She could have cared less about that. She politely yet firmly repeated herself. "Yes, but my brother makes good money and has excellent insurance and would prefer to be elsewhere." She looked over her shoulder at her brother who looked slightly embarrassed. Sister ignored him and kept rubbing her pony tail. "How does this work? The transfer?"

All of these questions came up before I got there. Them trying to figure out what the hell was going on with this young out-of-towner with his splitting head pain while keeping his six-figure sister from litigating right then and right there. When I spoke to the team they let out their frustration.

"This is interrupting care," my intern lamented with a heavy sigh. "It's totally distracting us from doing what's needed for him. She is criticizing our every move and it seems like nothing we have done is enough."

Hmmm. 

The story was intriguing. First the clinical part, and then the rest. Young, healthy guy throws back some martinis and gets a splitting headache. Stabbing like an ice pick, feels like he'll die. Work up is negative for subarachnoid bleed and surprisingly there are a few white blood cells in the cerebral spinal fluid.  The medicine nerd in me combed my mind for a differential diagnosis.

• Really early viral meningits? I mean it is the summer and it's the time for it. That's possible. Awfully sudden in onset, though. Naaaah.
• Cluster headache? If I recall correctly, alcohol can set cluster headaches off. More common in the dudes than the ladies. Usually stabbing. Like an ice pick. And he said "ice pick" not me. But why the white blood cells? Beats me.
• Aseptic meningitis and a cluster headache? Damn. Sure would be an unlucky chap, now wouldn't he. But the story sounds really cluster-y yet those pesky white cells still need to be explained. Can you get white cells with a cluster headache? I don't think so. Hmm. Need to look that up.
• Atypical migraine headache?
• Hypertensive emergency?
• HIV related?

Hmmm.

"Had he ever had headaches before?" I queried. I wanted to know. But honestly? That answer got buried under all of this talk of his sister and her stabs she was taking at Grady. Every question I asked was met with distracted mumblings about what to do with not so much him and his headache, but the headache of that situation.

"Were his symptoms all on the right side or also bilateral?" I continued with my questions.

So much for my answers. Instead, it was more and more about how bitter Mr. Ingles' "peoples" were about being here and about how "his sister is a judge or a defense attorney" or something legal up in North Fulton County which makes having her not-in-a-car-wreck brother even scarier for the intern and resident.

"She just won't listen," sighed the senior resident. He was right. To every word they said to try to allay Sister's concerns, all she would say was, "We have insurance, thank you."

Dang.

Let me tell you. . . .the team found this 100% uncool. It was obvious that they thought this woman was entitled and rude. I never gave them a green light to tear into Mr. Ingle's sister by saying a snide remark. Calling her a "hoity-toity" something-or-other would have nicely broken the seal, allowing for a nice little verbal bashing to vent the frustration. But I didn't, so nobody actually said it. They just huffed and eye-rolled when telling me about it and warned me of the fire pit I was about to walk into as we approached the room.

When I knocked on the door of his room, I was surprised to find him alone. I shook his hand and introduced myself. "Hi, Mr. Ingle, sir. I'm Dr. Manning and I'm the senior doctor on the team."

"Manning?" he asked confirming he heard right.

"Yep," I replied while showing him my badge. I tried not to fall prey to the paranoia my team had about this patient and his family but some tiny voice somewhere said, Mmmm hmmm. He's getting your name right in case his sister needs it later. I shook my head and decided that this was simply a patient that wanted to know his doctor's name.  I smiled and said, "That's right. Manning. Just like the football players but without their money." We both chuckled and I'm pretty sure I caught a twinkle in his blue eyes.  "How are you feeling compared to when you first got here?"

"A little better, actually."  He smoothed out the covers and patted around the bed for his phone. Quickly grabbing his iPhone, he switched it to a silent position.  How gentlemanly of him.

"Your blood pressure looks much better."

"That's good. Thanks."  Mr. Ingle smiled and it was as genuine as genuine could be. Honestly, he didn't look too bothered by the whole Grady thing. In fact, he seemed glad to be getting care and gladder to be getting better.

I briefly recounted the history and asked his permission to examine him. Once he obliged, I found him to be quite trusting. By the time I finished examining him he looked almost completely well. "How are you feeling now?"

"It's kind of weird," he replied, "I feel almost back to myself. Kind of crazy, I know."

And this is what convinced me that he probably had a cluster headache.  No, I still couldn't explain those 55 white blood cells in his CSF (cerebrospinal fluid) but 55 sure isn't 1,055.  The blood pressure was likely from the pain.  Just as I prepared to discuss this, in walked his sister.

Her  body language was terse and suspicious. She smelled like expensive cologne and kept her arms near her body almost as if touching something there could be a lot worse than death. I made direct and firm eye contact with her.  "Hello, ma'am. My name is Dr. Manning. I'm the attending physician on the team. It's good to have family here."

"Are you the person who can get him transferred? We don't want to be here."  Sister didn't waste any time. "Mark has insurance. I don't -- I mean he doesn't want to stay here."  Every time she reached up to rub her sleek brown pony tail her wrist full of David Yurman bracelets made a clinking sound.

I glanced at the patient and he looked away. Sister was in control and he wasn't going to challenge her. I stood there watching her and thinking. What do I say? How do we handle this?  I really wasn't sure.

"Ms. . . ?"

"Katherine Elliot. You can call me Katherine. I'm his older sister."

"Okay, Ms. Katherine. Listen, your brother is doing much better. His headache has resolved and his blood pressure is now normal. We're very pleased with--"

"Look, doctor. I don't really want to keep talking. Can you tell me what needs to happen for him to be transferred?"

"Well, honestly? He is looking so good that I'm not sure he needs to be in the hospital. I'd like to speak with my Infectious Disease colleagues to see what they say about --"

"We'd like another opinion. How do we get him moved to Northside?"

Whew.  This lady was rough.  I felt myself getting a little frustrated--with her for cutting me off and with him for not speaking for himself. Finally, I took a deep breath and decided to stop beating around the bush.

"Listen, Ms. Katherine. I need you to hear me for a moment."  She folded her arms and pulled her elbows in toward her torso. I had her attention. I took a big sigh and called out the elephant in the room. "Okay, so listen. I'm from Los Angeles and you guys are from Atlanta. One thing that most big cities have in common is that they have a hospital where all the poor people and car wrecks go.  In Atlanta, that's Grady." Sister didn't move. But she also didn't interrupt. I kept going. "You turn on television and you hear of the gunshot victims and immigrants coming here. You see the homeless people around the corner and hear of the drug-related incidents that find themselves here. Then you imagine your brother being in the same place or even room as someone addicted to crack or who just came from a shelter,  and the idea of it gives you the willies.  . . . ."

She cleared her throat nervously and continued to hold my gaze. "Well, listen Katherine. I get that. I really do. Like. . .I love Grady. I've worked here for ten years and I know the good we do. But honestly? I had two babies since I've lived here and didn't have either one at Grady.  And I'd like to say that it's because I didn't want to run into people I knew or residents or whatever but maybe it does have something to do with the fact that I had a choice."

The team cast nervous glances to each other.  They weren't sure where I was going with this.

"So what I'll say is that I get your concern. I really do. I won't stand here and insult your intelligence by telling you otherwise. Grady is different than some other places. When you're the only place that doesn't turn people away, your resources get used up fast. Things take longer and yes, you do run into some colorful people.  I get it. But Katherine, your brother is here now. And mostly everything that's going on with him is a lot better. I do need to review his spinal tap results with some specialists but he may not need further hospitalization."

"Well how do you know this isn't something more serious like a stroke?"

"Right now, the information we have doesn't suggest a stroke. His cat scan was negative. His spinal tap had no signs of blood--just some white blood cells but not really that many.  Our exam doesn't suggest a stroke either."  She loosened the grip on her elbows. Those icicles were beginning to melt. "I can't transfer him anywhere now. All I can do is tell you that I get your concern and that I'm not trivializing it. But at this point, it's hindering your brother's care to keep talking about moving him. Even though we have less resources here sometimes, as far as this goes, he got the same thing he would have gotten elsewhere."

He finally chimed in and said, "Thanks, Dr. Manning. Kath, I'm okay with this.  They've been great so far." She darted her eyes over to her brother and parted her lips to speak but nothing came out.

I added, "Again, I get it."

Katherine just stood there for a few beats and then slowly nodded her head. "You know what?  Thanks. Seriously, thanks for your honesty."

"Thanks for yours," I replied.

"Okay, so now what?"

"Now, we talk to Infectious Diseases to see if we need to do more about these white blood cells in the spinal fluid. If they say it's okay, we will discharge him. If not, we'll do what they recommend."  I turned my attention to Mr. Ingle. "How does that sound, sir?"

He gave me a thumbs up sign. "It sounds great."


So as the story goes, Infectious Diseases said that the white cells could have been some aseptic meningitis but more than likely weren't anything infectious. We even ran it by Neurology who agreed that this was all a bad cluster headache and that, though unusual, maybe those cells were from the inflammation of it all.  Mr. Ingle was discharged later that day.

I ran into his sister near the elevator a few hours later. She grabbed my hand and said, "I really appreciate you admitting what you admitted to me."

I smiled and shrugged.  I wasn't exactly proud of that fact.

"Dr. Manning? You know, doctors can really be some hypocrites. That's what made me appreciate that so much."

I didn't know what to say, so I just said "thanks" and waved good bye.


No. I am not marching through Grady announcing that I have insurance to every person who will listen. But . . . .not unlike her... . . something at some point has made me feel entitled to something other than Grady.  And right now, I'm just reflecting on that.  I'm also reflecting on how annoyed everyone was with Mr. Ingle's sister that day. . . .

And now I'm wondering just how many of the people on my team that day receive their care at Grady. I had to admit that I haven't. So? Who among us Grady doctors gets their paps and prenatal care and prostate exams and elective surgeries amidst our beloved indigent patients? Well?

Hmmm.

Guess I'm reflecting on that word "hypocrite"  a little bit, too.

***

Rounds with Roy A.

One of my favorite ward months ever was with Roy A. (who later became one of our chief residents.) He was (and still is) what I like to call "scary-smart." Kind of like my friend Lorenzo D. (the one who inspired the term.) Anyways. Today I thought of scary-smart Roy A. and all that he taught me that month. I amused myself thinking of the look on my face every day on rounds with Roy. Lawd. The things he came up with! I'm talking the most obscure of the obscure to the most relevant of the relevant. No matter what it was, Roy knew at least a little something about it. And. . .dare I say it? A whooooole lot of times he knew more about it than his attending.  Sure did.  

That Roy. He was so bright and fun to work with. Man, I learned a ton from him. Yeah, I said it. I learned a TON from him, my resident. Sure did.

You got a problem with that?

Here's a re-creation of me on wards with Roy A. . . . .

At the end of the month, Roy said, "Oh, Dr. Manning! I learned so much working with you! Thank you so much!"

And I was thinking, "You learned so much? Uhhhh, okay."

***
Happy Thursday. Oh--where is Roy now? Somewhere scaring the stethoscopes off of the Cardiology attendings in his Cardiology fellowship as we speak.

Grady Verbatim: What have you done for me lately?

This weekend on rounds at Grady:

"You haven't done NOTHIN' for me! NOTHIN'! I mean I know you SAVED MY LIFE and all THAT but OTHERWISE? You haven't done NOTHIN' for me!"



Ummm, okay.

***

White coats and questions.

*story shared with permission.

On Saturday, our first year medical students received their very first "white coats" in a symbolic program called "The White Coat Ceremony."  Family and friends came from near and far to witness the event--okay and maybe. . .just maybe. . .to lay eyes on their children and see where all of their money is going.

The day was beautiful. It was so lovely that I tossed my high-heels into my purse and walked to campus that afternoon with a pair of flip-flops. It was as if God himself smiled on the day and decided to make the sky just a little bit bluer and the grass just a little bit greener.  Yes. That day was in technicolor.  But more spectacular than those colors was the energy.  I don't even know how to describe it.

I met so many special people.  I loved the proud twinkle in the parents' eyes when I introduced myself to them. Kind of like meeting one of their children's professors sealed the deal. Yes, my baby is in medical school and my baby is going to be a doctor.  I guess that is something to be proud of, huh?

Well. The entire day was my favorite day. It started casual with soccer and folding chairs and water bottles.  That part was awesome. Then all of that soccer-awesome seamlessly changed over to all of this white-coat-awesome. I realized after seeing all those parents beaming with pride that all the proud-mama-ness that I feel during soccer is really just the beginning. Wow.

half soccer-mom/half amazing

Anyways. It was a special day. But. If I had to pick the very best moment of it all, though, it would have to be this:

After the ceremony we all walked around greeting the families and hugging our newly minted "M.D. candidates."  Some I'd heard about, some had heard about me, and most times a little of both.  There is this one student who shared a week with my team on the wards during the first days of school. The experience was rich and brimming with teachable moments, and he, along with one of his other first-year classmates, drank in every drop.

Unfortunately, there was one part of that week that was bittersweet for him.  His beloved grandfather, who happened to be an Emory School of Medicine alumnus, was nearing his final days.  He was candid in sharing this with me, and of course, I understood his need to abbreviate the week to return home. The day after I learned of this situation, I was surprised to see him on the wards.

"What are you doing here?" I asked him incredulously.

"I decided not to leave yet. I'm going to play it by ear," he said. "I want to stay a little longer."

Play it by who? Say what?

I was really troubled by all of this, quite honestly.  I wanted to send a message to him and the other team members that family is always first.  I needed him not to be heroic by rounding with me at Grady instead of being with his granddad.  But he was firm in his resolve. This student had clearly given all of this careful thought--it was what he wanted to do. I respected his decision.

At the end of that week, I sat the students down to debrief what they'd seen. We discussed their experiences and explored how it made them feel about medicine.  Then I asked about my student's grandfather.  "How is he doing?"

"I will be heading home shortly," he softly replied. "Mom says he's not doing so well. It's getting close."

"Did he know that you were going to be starting medical school at Emory?" I had to know.

"He did."

We all sat in silent deference.  He broke the hush by saying these words. "You know. .  . my grandfather. . .when he heard I was going to be starting med school he said to me, 'When you get there, go off by yourself and just walk around. Look around and ask yourself if this is really what you want to do.'"

I kept my eyes fixed on his and probed. "Did you? Did you do that?"

He nodded quietly.

"What did you decide?"

"Yes. This is what I want to do," he spoke firmly while still holding my gaze.  Then he looked around the room and continued. "My grandfather did his internship right here at Grady Hospital. He and my grandmother lived right up the street from Emory, too.  You know. . . it's almost like I could feel him with me this week. Like. . . like he was there, you know?"

My eyes welled up with tears as his simple truth rang like a tiny bell in my ear.  I cleared my throat of the mounting emotion and said, "So your decision to stay---" I pressed my lips together to keep from crying "--was a decision to be with your grandfather after all."

He smiled bravely and sighed.

Ah hah. Your decision to stay was a decision to stay. Ah hah.

And there we sat. Taking in the magnitude of that moment and what it meant to him to be at Grady Hospital. And now, what his presence for those days meant to all of us.  I tried to imagine his grandfather as an inquisitive medical intern at Grady, scuttling through the halls with hospital whites on. Wow. I felt honored to be the steward of his grandson's experience that week.

"Dr. Manning? This is my grandmother."

This is what I heard that student say to me after the ceremony on Saturday. I faced him in his pristine white coat, filled with the promise of a young doctor's future. Surely that very promise his grandfather held some four decades before. Then I turned and rested my eyes on his grandmother.

I took the hands of this elegant matriarch and took in the complex mixture of pride and sadness in her eyes.  She was beautiful, both physically and spiritually, and I was so glad she was there.

"I am so, so honored to meet you," I emphatically told her.  I meant that because that is truly how I felt.  I knew that after losing her beloved just one month before and taking in the sights and smells of a place she shared with him was hard. But she was there. Strong, resilient, grief-stricken--and there. This was a big deal.

She offered me a smile so tender, I thought I'd cry right then and there.  I composed myself and told her what her grandson had done. "Your grandson brought your husband's legacy to life for us. He honored him by sharing his lessons and mostly by sharing his story.  He also told me all about you.  You know this already but you have a very special grandson."

We instinctively hugged, and it was right.  A knowing hug filled with mutual gratitude for the continuum of life as we know it.  "He is in good hands," I whispered to her.  "And so are we."

She nodded and hugged me once more. And yes, it was still right.

That was just one moment. But do you know there were several others that closely mirrored this? Like for every student there was an intricate tapestry of family and love and sacrifice trailing behind them. I loved seeing it, and just like those students during that first week on the wards, I took in every single drop.


When I walked home, I thought of that encounter with the elegant matriarch repeatedly.  I took in the neighborhood and imagined what it must have been like when she'd walked this very thoroughfare many years before.  Man. I sat on a bench and took a moment to reflect on what this all meant. Me telling this woman that her grandson was "in good hands." Us knighting our students with white coats. The charge we have as stewards, really, of someone's professional upbringing.

Wow. This is a lot.

For the rest of that walk, I took that sage advice and asked myself that question. "Is this what you really want to do?"

Yes.

***
Happy Monday.