Oh, how I love this song. So much. It's such a haunting song, you know? I love that the song writer has never really been clear on what it means. Like, is it really literal? Like has something literally made him lose faith? Or rather faith in his Faith? Or how about in someone? A regular someone? A deity? Or none of that at all?
Hmm.
Yes. I'm of Christian faith. But I still love this song. So much. Mostly because I think it has nothing really to do with organized faith. Or any of those things that the talking heads in the primaries are fighting over. Which interestingly aren't things that intensely matter to me, a person who also happens to be down with Jesus. And even if it is literally about organized religion, so what. It makes me think. And thinking is good. Even for people who are believers in assorted faiths.
Anyways.
I just think it's such a layered song. With such a bold title and hook. That mandolin, that pleading in the vocalist's voice. It punches me in my chest and makes me stop what I'm doing and think. And wonder what it means.
And you know? Every single time I hear this song, I think of a new meaning. That's what makes me love this song so much.
I love things that can have many interpretations. Don't you? Because I think life and people and everything are like that. Open to many interpretations. Changing interpretations, too. Remixes and revisions and redemption, too. Kind of like my take on this song every time I hear it.
Some days I can even relate this song to my writing here. Like, I say to myself after hitting publish: "Oh no, I said too much." Or even, "That's me on the corner. . . .that's me in the spotlight . . . .losing my religion. . ."
Then I will feel a pang of fear. Like I revealed my clay feet or zoomed right in on my Achilles heel for the whole world or rather, world-wide web, to see.
But like Michael Stipe who wrote those words, that hint of fear somehow bolsters my fearlessness. It makes me want to be transparent and to write things that make people think and feel and even come back to read again. For a new take. A new interpretation.
And to be a little more okay with their own clay feet.
Zachary heard this song playing on my computer and came over and sat on my lap. He sat there quietly listening and watching and seemed mesmerized by the mandolin and Stipe's voice. Then when it ended he looked over at me and said, "Can you play it again?"
And I did.
this morning in my kitchen
We sat together and watched that video all over again, too. And he watched the images and asked me questions like, "Do you think that man is an angel?" And I said, "I don't know. Do you?" And he looked and said, "I think he is. Maybe he is trying to cheer the singing man up." "Hmm. Do you think he seems sad?" I wanted to know. So he told me his thoughts. "He seems like he lost a friend. And like he feels sad about it." And I looked and watched some more and that little five year-old observation opened me up to yet another interpretation of this song.
Maybe he lost a friend. Or faith in one. Or himself. Or something.
I don't know. I just love this song. And what's cool is that now my five year-old child does, too.
The official video used to be un-embeddable. But hey! For some reason, it can now be embedded. So until someone blocks it, here it is. The original video to "Losing my religion" by R.E.M. that my friend Ms. Moon says is the reason videos were invented.
And I think she is right.
Do you love this song, too? What's your interpretation?
Or better yet.
What other song does this to you? Makes you think and wonder and try to interpret over and over again? Maybe I haven't ever heard it. But I'd love to. I really would.
I was holding a patient's hand yesterday. She was the last person I was seeing on rounds that day and it had been a long day. I was feeling over-scheduled and over-tired and over-everythinged. The clock was on my back and the list of things I had to do at home was just as long as the one I had finally finished at work.
I needed to go.
It was already 5:20 P.M. The sun was already on a downward descent and late afternoon sunshine was peaking lazily through hospital blinds. And today, there wasn't much going on with her so I felt confident I could get out in time to get both kids on time.
If I hurried, I'd be just fine.
There was a procedure that she'd needed and that procedure had been done. She'd tolerated it well and all of the teams of physicians caring for her were now working in a lovely three part harmony. Plans clear. Clinical course, at this point, predictable.
This was supposed to be a quick in and out visit. A chance to check on her pain and see if she needed anything. What would work best for my schedule would be for her to say, "Nope, I'm good" or even ask one obligatory question to which I could quickly answer.
Not so fast.
"Hold my hand," she said. She was telling me more than asking me, so I sat down on the edge of her bed and did what she said.
"You okay?" I softened my voice to let her hear my concern. And to hide my ticking time clock.
"I'm fine. I just want you to hold my hand for a little while that's all."
What? But. . .
"Okay," I answered. "I can do that." Because even at 5:22, I could. At least for a moment.
So I held her hand and waited for her to say something but she didn't. She just sat there watching Judge Judy and not even looking at me. The silence was killing me so I made some small talk.
"Are you moving your bowels okay?"
"I am." She nodded her head while saying that. Keeping her eyes on Judge Judy.
"Any pain?"
"Just a little. But the pain pills help mostly. So mostly no pain." She shook her head. Back to Judy.
"Okay."
I softened the grip on her hand and she sensed it as the warning that I was trying to leave. Her fingertips pressed into the back of my hand.
"Don't go. Can't you just stay with me for a little while?"
Eyes off the television and now on me. I didn't respond. Instead I just sat still to show her that I'd try to stay a little longer. Even though I really needed to go.
Like, for real.
I looked into her eyes. They were unusually wide like brown saucers.
"You sure you alright?" I finally said.
"You know? Nothing is wrong right now. I just like you. I like your voice and how you look at me. It makes me feel better for some reason."
My face immediately grew hot.
"I like you, too." That was all I could think to say. But at least it was true.
After a few moments, she let my hand go. Then she said, "I know you got to go. You probably got to go on home or see other patients and I know that. I can tell you a busy person. But you know what? You got this special thing about you that don't make people feel rushed. Even when you in here quick it feels like you got time for me."
Wow.
I sat there speechless. I thought about how many times this week I'd already told my kids to "hustle up."
"If you feel rushed I guess it don't even matter if it's not a rush," she added.
I thought about the last thing I'd said to Isaiah as he dawdled that morning before school. "Come on, buddy. Sense of urgency, bud, let's go. Hustle up." Even though we were making good time this morning.
Yeah, hustle up.
"I guess perception is reality."
She looked over from Judge Judy. "What's that, Miss Manning?"
"Just what you said. What it seems like might as well be how it is."
"Yeah."
"You know what? I was kind of in a hurry when I came in here. I can't lie."
Now she was off of Judy for good. She smiled at me sideways.
"But you didn't make me feel like that, see."
"Hmmm."
I squinted up at Judge Judy and then looked back at her. The verdict was just about to be rendered. This let me know that it was very close to 5:30.
And that I still needed to go.
"You know? Some days I'm pretty sure I don't get it right."
"Today you did."
I grabbed her hand again and squeezed it. "Man. I kind of needed that today. You must have sensed that I did."
"No, Miss Manning. . . you know. . . actually I didn't."
"Well, it seemed like you did." We both chuckled.
"So what it seem like might as well be how it is. Right, doc?"
"Right, indeed."
I paused for twenty more seconds after hearing Judge Judy bang her gavel. Judgement for the plaintiff. The credits started to roll and a commercial came on.
"Alright then, Miss Manning." She gave my hand a pat of dismissal.
I stood up to leave and headed toward the door. I flicked off her light switch and replied, "Alright then."
Heart pumping. Hard. I bet you they can hear it. Do I look nervous? Don't look nervous. Relax. This is not that big of a deal. Just open your mouth and talk. Simple.
"You ready to present your patient?"
"I think so."
Shoot. I should have said something more definitive like, Absolutely! Shoulders back. Head up. Look confident. Even if you don't feel confident. You can do this. You totally can.
"Excuse me--sorry to interrupt your rounds--but is Mr. Albertson your team's patient?"
My senior speaks up first. "Yes, Ms. Johnson. Is everything alright?"
Dang. How does she know every name of every nurse? I think I will try to learn their names, too. Johnson. Johnson. Johnson. Got it. I think.
"He's a bit agitated. I haven't had him in a couple of days and hadn't seen him this way."
"Hmm. Let's go and check it out. Thanks, Ms. Johnson."
Johnson. Johnson. Johnson.
"Hey--push pause on that presentation for just two seconds, okay? Let's go see what's up with Mr. Albertson."
"Sure. I mean, absolutely." Hope that didn't sound as dumb as it felt like it sounded.
In we walk. A whole big team of white coats and industrious expressions. The long coats with the surest footing. Me, I try to keep up. Mimic it all in my short coat.
"Hey there, Mr. Albertson! What's going on?"
Wow. My senior resident is awesome. So confident. I want to be more confident. Shoulders back. Head up. Like her. Yeah, like her.
"Nothing is up! I just need to go water my lawn!"
Lawn? Rut roh. Mr. Albertson is more than just agitated. He's confused. Or as my senior and everyone around here says, "altered." Short for "altered mental status."
My senior looks over his medications and through the electronic chart. The intern begins to ask him more questions and they examine him. I watch from the foot of the bed as Mr. Albertson writhes about with wrist restraints on and also against the ones on his ankles.
"My lawn! It's gon' dry out!"
"Where are you sir? Do you know where you are?"
"What? I'm at my house! 2733 Hopkins Place Decatur, Georgia."
Now I may be new but I know that this isn't his house. I stayed quiet as my senior and intern continued to discuss his mentation.
"I think he could be sundowning. He is eighty-four you know. No fevers or anything." Sundowning. Of course. The intern said this with that confidence that I wish I had so bad.
"That's possible. But that should be a diagnosis of exclusion." My resident scrolled through the medications on the screen as Ms. Johnson came back into the room to flush is IV. "Hmm. What about this Ambien? This could be the problem."
"He hasn't been getting that," Ms. Johnson replied nonchalantly.
So much for that. I stood there feeling. . .I don't know what I was feeling. Unhelpful? Nervous about still having to present my patient? Something. I felt something. I decided to keep quiet. Look interested and engaged. That wasn't hard to do since I think I actually am feeling both of those things.
The room is quiet. People are moving and checking and scrolling and doing. Me, I'm just standing there. Zoning a little bit but not really. I look at Mr. Albertson and feel bad about his lawn. I wish we were at his house, actually. So that everyone would stop calling him "altered."
I look at his arms and feel bad about those restraints, too. My brow furrows every time he beats his wrists against those soft cuffs and this time, that nurse saw me.
"He yanked his Foley catheter clear out on Sunday. Balloon inflated and all." She said. I guess she needed to explain to me why we had him tied down. I had already assumed it was for his safety, but appreciated the fact that she actually spoke directly to me.
I jumped at the opportunity and asked her a question. "Ms. Johnson?" Johnson. Johnson. Johnson. "What was his temperature?"
She looked down at the sheet in her hand. "Excuse me, baby? Oh, it was. . .let's see. . . .35.4. That's celsius."
I love how everyone stops to interpret things for the new med student. I nodded and felt something happening. There were mechanical sounds in my head and I think that--just maybe--it was the sound of my wheels turning. Say something? Jump in with my thoughts?
"Could. . . " I thought about taking it back right after spoke. Everyone swung their heads in my direction. Alright. Now they're looking at me. Might as well jump. "Could. . .um. . .like. . .maybe he could have like a urinary tract infection. . from, I mean, because he . . . well, he has a Foley catheter. So maybe a UTI? Or like, urosepsis since his temperature is low?"
There. I said it. Could be a dumb thing to say but it was at least a thought. And honestly? This was my first unscripted thought or statement so far. Deep breath. Shoulders back. Try to look confident.
"That's a really good thought." I looked at my resident and waited for the obligatory "but." It never came.
"The restraints could also be making things a little worse?" That's what my fellow student said. And I remembered someone telling us that, actually. I smiled at him and felt proud of us. Wheels turning and everything.
"You know what? You all have great points!" the intern exclaimed. "Our students are awesome."
That part sounded kind of patronizing but hell, I'll take any compliment I can get. Our resident was still focused on Mr. Albertson and his labs and his perturbations in mentation.
"Gram negative rods. Wow." She opened up a screen on the computer that had just reported a new value from a blood culture. "Urosepsis. You're right. He's infected."
I could feel my heart pounding. Harder and louder than it had before. Guitars playing like crazy in my head. Want to drop to my knees like Eddie Van Halen.
"Let's get him some Ceftriaxone right away. I'm entering the order now, Ms. Johnson."
"Okay, baby."
The only sound was that of my resident typing that order into the electronic record. That and my heart pounding.
"Let's get him out of bed and into a chair, too. We can take off the hand and foot restraints and just use a soft Posey vest to keep him safe. And a one to one sitter."
"You got it," Ms. Johnson responded to my resident once again.
Wow. This is what it feels like to contribute. To help.
"Orders in, Ms. J. Let us know if you need anything else or just page us with any changes."
"Thanks."
"Thank you for letting us know, Ms. Johnson. Alright guys. Let's get back to hearing about this next patient." My resident waved her arm and we followed her sure footing once again.
For whatever reason, I was the last duckling to file out of the room. Johnson. Johnson. Johnson. "Um, thank you for your help with him, Ms. Johnson."
She smiled at me wide and genuine. "Thank YOU for yours."
My heart. Now? It might explode. My feet are lifted like a gust of air has been pushed under them. Team waiting for me in a semicircle. Looking. Watching. Waiting. For me.
I step into the group and my resident is standing directly across from me. Without saying a word she holds up her fist directly aiming it at me. She nods slowly and smiles in approval. All eyes on me. Me. Heart about to leap from my chest. Guitars wailing, howling, squealing at such a high pitch that I'm afraid a window will shatter. This was my celebratory fist bump.
*Bump*
"Hypothermia can be a sign of sepsis. Particularly in the elderly." My senior said this and then added in a few more teaching points that all hinged upon my wheels that had turned right there in that room. I listened and learned and heard things that I didn't know before. Feeling myself learning. Yes. Yes!
"Alright. You ready to present your patient now?"
All eyes on me. Shoulders back. Head up. Heart still pounding. Come on. You can do this. Don't be nervous. Go ahead. Jump.
Ten things I am thinking about and feeling thankful for this morning--some deep and others, not so much.
10. These two dudes
Spoke with my friend Christina P. the other day. She just had a baby a few months ago and she said, "I wanted so badly to be a mom. I had no idea I was capable of such love." Then she said, "I remember something you said about being a mom. You said, 'It's the only thing you've ever deeply wanted that turned out to be even better than you thought once you got it.'"
Yes. Yes. And yes.
9. This bag my mom let me borrow.
It's a great bag, I tell you. It also makes me think of my mom every time I carry it.
"That bag is so cute, Tounces!" I said to my mom. (Tounces is yet another name I call her.)
"It is cute!" she replied.
"Don't you want to let me carry it?" I asked her with a dorky smile.
"Sure. You can."
That was that. And no, it wasn't a bag she grabbed off of a Walmart shelf. It's a good, sturdy leather bag that she paid good money for. And that she then let her daughter carry.
8. Nice people.
Yesterday when I went to pick up Zachary from school, I stopped in the office to chat with Coach B. who helps run after school care. Every single time I see her, she makes me feel glad that I did. On this day, I asked her about her daughter who happens to be a Grady nurse.
"She's getting married!" she gushed.
So next, I asked all about the wedding plans and loved hearing all about the joyful whirlwind sweeping up her family. I love asking about her daughter because she speaks of her so lovingly. Hearing about her daughter getting married was even better.
Also.
One day I got stuck in twenty tons of wretched traffic on the way to after school care. I am never (okay rarely) late getting the kids, but on this day I was. And by a rather substantial amount--like twenty five minutes. When I walked in panting and fretting, I found Coach B. sitting on a chair calmly reading a book to Zachary. I profusely apologized and prepared to pay the late fee.
"That's okay," she said. "Don't worry about it."
And that was it. No pomp. No circumstance. Just a random act of kindness.
Man. I deeply appreciated that. I think I told her before. I hope I did. Because she was the bright spot in what had really been a crappy evening.
7. My sun room.
It's a great room for teaching. And just for living.
6. Laughing with my Dad over the phone.
My dad tells the best jokes ever. No one tells a story like he does. And he's just so damn funny sometimes. I love our chats.
5. Smartphones.
My friend Mary Jo sent me a picture she'd taken of a rash on one of her kids. Then we had a big discussion over text message about it. It was fabulously nerdy and I can't wait to see another picture today.
I asked my friend Carlos D. a question about syphilis in HIV over a text on Friday. He quickly responded with all kinds of good nuggets of wisdom. One time, he texted me back from the dais at the AIDS VACCINE International meeting!
I also looked up a recipe in the kitchen on my iPhone yesterday, too.
4. Good friends.
I have some very good friends. I really, really do. My husband has an amazing set of close friends and now that I think of it, my kids have really good friends, too. It's good to have good friends. I'm thankful for that.
3. This lady right here.
This is Sakinah. I met her the first week that I moved to Atlanta after someone referred me to her. I had just cut ALL of my hair off before moving to Atlanta from Cleveland and she became my stylist.
She is simply THE BEST. I mean it. I fall asleep in her chair while she's cutting my hair because I trust her so much. She cuts my hair every two weeks and has for ten years. She made me feel beautiful on my wedding day and treats every time like it's a big occasion.
And. I have never once been disappointed. I am so thankful for her.
Oh--and on top of that? She's really cool and very wise.
2. An excellent resident on wards this month.
My resident this month is Adaeze A. She is wonderful and smart and responsible and mature. I was her very first attending on her very first ward month as an intern. And now I get the honor of being her very last attending on her very last ward month as a senior resident. What a joy!
Yesterday, it was just the two of us. Me and my nearly fully-bona fide fellow Grady doctor. And so. We took great care of patients together while enjoying leisurely rounds that felt more like girlfriend time than work. Our joke is that when we work together we discuss the following:
Heart failure -- and hair care.
Relationships -- and reticulocytosis.
Pneumonia -- and new shoes.
Marriage -- and multiple myeloma.
(You get the picture.)
Best of all? I trust her. There is no higher compliment that you can pay your resident.
1. This dude right here. (Of course.)
He's hot. He's responsible. He's loyal. And he grills. What more could a woman ask for?
***
Bonus: Cafe y cilantro.
My breakfast this morning. Eggs over hard plus La Fonda salsa. Yes, again.
Confession: I don't know what's wrong with you. No. I mean, literally. I really don't. I have examined you repeatedly. I have carefully pored through your labs and your medications. I have spoken to the consultants and reviewed the multiple pictures taken of your various body parts. And still. I am no closer to knowing an answer than I was when I started.
I ride the elevator thinking about you. Maybe this? Oohh! What about that? And then I run to the nearest computer to look it up only to find that, no, your situation isn't consistent with any of those things. That or the fact that somebody else already had thought of that before my elevator epiphany and ran a test already. Which also came back negative.
So here I am. Right back at square one. Five days into caring for you and as perplexed as I was on the first day. And it's not like you're necessarily worse. But still, you aren't better. At all. And me? I like seeing people get better.
No. It doesn't work like people think it does. Or how they show it on television. We don't always know the answer right away. A lot of times we do. But there are definitely times where we don't. Nope. It's not like House M.D. or E.R. And it's not like Scrubs or Grey's Anatomy, either.
(Okay, maybe my team does get pretty close to Scrubs at times, but that's not the point.)
The point is that that guy House on House M.D. strolls right into hospital rooms and effortlessly turns those perplexing patients like you into sexy ah hah moments. Wrinkling his brown and twisting his mouth until suddenly--ah hah--he asks if anyone thought of, oh, I don't know, cyanide poisoning or something. (Because clearly had anyone simply asked about the cyanide leak in that apartment building, they'd have put that all together.) And just like that, he saves the day within the sixty minutes allotted for solving the case.
But Dr. House isn't a real doctor. He just plays one on T.V. And those patients that he sees? With their cyanide poisoning and their acute intermittent porphyria are actors paid big money to put on fake backless gowns and force out real-appearing tears. But you are more than just a real-appearing patient. You are a real person with a real problem. And, so far, I can't solve it. Because I still don't know why you have it or what it is.
Grrr!
These are the times that I wish I didn't care. The days that I wish I was cool with just shrugging my shoulders and saying "oh well!" But, see, I do care. I sure do--and so do a whole lot of other people.
But still we don't know what's wrong.
So now I am about to read some more and think some more about you. I'm going to examine you some more and ask as many smart people as I can about you until someone finally says with twisted mouth and furrowed brow, "Ah hah!"
And just maybe . . . if we pay attention. . . that smart person will be you.
Woke up early in a quiet house because my children had spent the night with their grandmother. (Thanks, Shugsie.)
Also woke up after sleeping "spread eagle" across the bed because my lover the BHE was out of town on a weekend trip with his college friends.
Surprised myself by just how early I woke up after sleeping "spread eagle" considering how late I'd stayed up watching "Juno" for what I am certain is up to the double-digits in number of times watched.
Listened to this version of this song:
Realized that I love this song no matter who sings it.
Sat at my kitchen table watching all of the runners go by through the window. Damn. We have a lot of runners going by in this neighborhood.
Thought about joining those neighborhood runners but decided instead to savor my moments before going in for rounds.
Drank coffee out of a Snoopy and Woodstock Christmas mug.
Didn't feel bad about being at "bedside baptist" that morning since I knew I had to work.
Caught up on some of my favorite blogs while smiling at Snoopy and Woodstock.
Realized that I should probably be catching up on the overnight events of my patients, so swapped over to the electronic medical record.
Decided to have myself a real breakfast (which, for me, meant two eggs over hard drenched in the left over salsa I had from La Fonda Latina.)
salsa from La Fonda
Wondered if the mixture of coffee and cilantro this early in the morning was such a good idea.
Decide that both coffee and cilantro are always a good idea no matter what.
Dug through the kids' drawers for soccer things after remembering that spring soccer practice was starting that afternoon. (Thanks, Harry.)
Wondered just how bad it would be to practice with one size 12 soccer cleat and one size 11 soccer cleat. (Especially if you wear a size 12 1/2 soccer cleat.)
Threw on clothes and dashed to Grady after the soccer search became futile.
Laughed when I saw my two interns, Doug and Matt, who had dressed identically on accident.
No, seriously. Identically.
Decided that a blue oxford, khaki pants, and brown loafers could absolutely put you at risk for having a twin on any given Sunday, Monday, or Tuesday in the Southern United States.
That or seersucker. Southerners dig the seersucker thing depending upon the month.
And the hoity-toity ones like Lily Pulitzer which I admittedly don't fully understand.
Developed an attack plan for rounds with my twin-terns because you always need an attack plan.
For me, that attack plan always involves trying to set an E.T.F.R. (estimated time finishing rounding.) Because if you just round all day and never get work done, that kind of sucks for everyone. Patients included.
Had some very effective management rounds with the twin-terns and made some solid decisions.
Stopped by our patient's room and played "rock-paper-scissors" again after examining him.
Called the Spanish interpreter who met us on the floor quicker than you can say "Rumpelstiltskin."
Was really glad to see that it was Alvaro, the same interpreter who'd helped me the day before.
Reminded my twin-tern that they are "interpreters" and not "translators" because translation is from written to written and interpretation is from spoken to spoken. (And because it annoys them to be called "translators.")
Realized that calling the interpreters means acquiring a bunch of new friends in the hospital since I had been underutilizing their expertise.
Sat at the nurses' station and laughed with some of my favorite nurses after meeting our E.T.F.R.
Created an attack plan for what needed to be done before achieving my own E.T.L.G. (estimated time leaving Grady.)
Factored laughing with my favorite nurses into that E.T.L.G.
Re-grouped with my twin-terns before preparing to leave. Laughed again at the fact that they were dressed alike and at myself for being witty enough to refer to them as "twin-terns."
Headed home to restart the soccer search.
Made it to Mom's house to snatch up Thing 1 and Thing 2.
Was in a hurry so rapid-fire changed boys into soccer gear (which kind of looked like those models backstage at fashion shows since it involved me, my sister and my mom.)
Was proud of myself for making good time.
Wanted to bang my head on the steering wheel when Zachary announced his favorite thing to announce as soon as I get on the highway and when I am in a hurry and on the tippy-tip edge of making good time: "I have to poop like really, really, really, really bad and I CAN'T hold it."
Wondered if there could possibly be a more regular child that Zachary.
Tried to gage how many "reallys" constitutes actually stopping before getting to the soccer field.
Answer: five.
May have uttered an expletive or two while pulling over to deal with Mr. Regular.
Ignored the lady in Subway when she said, "Hey! No public restroom, ma'am!"
Felt annoyed as Zachary commenced to strike up a conversation with me while being hoisted over the non-public bathroom commode. Seriously, kid?
Got to Zachary's soccer practice a few moments late but avoided what could have been a very ugly situation.
Felt annoyed that there was an hour between Isaiah's and Zachary's practices but relieved that they were at the same field this time.
Realized how cold it was outside after watching the kids gyrating and with teeth chattering.
Discovered that Isaiah's very best friend is ON HIS SOCCER TEAM. (This is an extremely big deal, people.)
Made it home and was extremely happy to see the BHE.
Threw those dirty boys straight into Harry's truck and went to Chili's for dinner (upon the kids' request.)
Ate a surprisingly good steak at Chili's. (That or I was just hungry.)
Sent funny text messages to my friend Lesley M. which included "How YOU doin'?" (Wendy Williams version, not Joey Tribbiani version.)
Read the electronic medical record again after tucking the kids in.
Fell asleep four times on the Atlanta Trainwreck Housewives before finally giving up and going to bed.
Fell asleep four more times while attempting to pray and finally said (with a big ol' yawn) what the Grady elders say: "Tha's alright. . . the Lord know my heart."
Decided to just lay there and feel thankful for another day.
Back on the wards and man! Don't even know where to start. How about a top ten?
Don't mind if I do.
I bring you. . .
THE TOP TEN MOMENTS ON THE WARDS
IN THE FIRST THREE DAYS OF MARCH
And no. I have not taken the time to really edit this, so forgive any typos in advance. (Got that, Shug?)
#10 -- All the single ladies?
So on the first day of wards, I step onto the A elevators heading down from the floor. The doors open and there's four or five youngish dudes standing inside. Well, not even just youngish. They were young, for real. So anyways, I join the young dudes and am immediately reminded that just maybe I still have my mojo (if being looked up and down with a creepy smirk counts as having your mojo.)
Yeah, so finally one of the dudes hits me with the Wendy Williams "how YOU doin'?" and I sort of giggle and nod in reply.
So we ride. And they creepy-smirk. Finally we reach the ground level and the doors part.
And guess what? Do you know all four of those young dudes stepped off right in front of me? Maaaaan, in my head, I was like, Can a sister get even a little bit of chivalry?
So I say to them, "Maaan, can a sister get even a little bit of chivalry?"
To which the how-YOU-doin' dude says, "Get a little bit of WHO?"
And I was like, "How are all y'all just gonna step off the elevator first? What happened to 'ladies first?'"
So the spokesperson dude looks at me incredulously for two seconds and laughs. Then he says, "You MARRIED!"
And I'm like, "What the heck does that have to do with y'all letting me off of the elevator first?"
We all laughed but they stuck to their guns. Another dude, not even the how-YOU-doin' one says the same thing again, "Yeah, you MARRIED!"
"Wait. . . . so if you're married then. . . you . . .no longer get ladies first?"
"Tha's what your husband is for."
This was the reply. And seriously? They meant it.
So. . . .the point of me telling you this? Uh, zero. It was just funny.
#9 - Ro-sham-bo!
This morning on rounds we asked our young patient this:
"What questions do you have for us?"
And he said, "I don't have any."
That wasn't surprising. Even though he wasn't even legal yet, with his chronic medical problem he knew the ins and outs of how such hospitalizations work. Then he added:
"Wait, yes I do. I have one question."
"What's that?" I asked.
"Do you know how to play 'rock, paper, scissors?'"
"Do I?"
Our patient smiled for the first time at that point. A big, bright smile that peeled back his lips and showed all of his teeth and a whole lot of his gums, too. That smile brightened up that room.
"Alright, let's see who wins!" he announced while squirming to sit upright in bed. I loved how boyish and playful he was about it, too.
And so we started. Me, the patient, the resident, and the intern. Playing rock-paper-scissors which I hadn't played since Isaiah was a newborn and Harry and I were trying to determine who had to wake up next.
"Rock-Paper-Scissors. . . . Shoot!"
The best part: Our patient won. Best out of three.
#8 - Sugar pie honey bunch (but not like that.)
Patient was lying in bed this morning. She's been very, very short of breath so we wanted to limit her talking. I saw her alone on rounds today. She was resting on her back with her eyes closed which she opened only for a moment when she greeted me.
"Hey, sugar."
"Hey," I replied. "How you doin' today?"
"Good, sugar."
"Your breathing?"
"If I stay still, it's okay, sugar."
"Okay. Can I listen to you?"
"That's fine, sugar pie."
Sugar pie. Sigh.
I listened to her chest and back. Felt her tummy and made sure she was okay. When I got ready to leave, she opened her eyes again.
"You beautiful." She smiled at me and squeezed the hand I was already holding.
"You are, too."
She closed her eyes again and looked like she was falling asleep. Then suddenly they flung open.
"I wasn't trying to sound funny. Like. . .I meant you beautiful like inside and out. Not like you beautiful like I'm trying to date you."
Wait, huh?
I smiled and then laughed because that was the last thing I thought this grandmother was saying so it was funny.
"Nawww, I never thought that. I got what you meant."
"Oh okay, sugar. 'Cawse, you know, I didn't want you thinking I was trying to be all like 'how YOU doin'?'" She gave a weak laugh and then coughed.
Not. Kidding. That's what she said.
And okay, the dude on the elevator didn't really say it like Wendy Williams but her? She really did.
#7 You smell me?
A man gets on the elevator with me on Thursday.
"Damn! Somebody in here smell good!"
Then. He commences to sniff person after person on the lift. And I am thinking we should have moved away or something but for whatever dumb reason we all just withstood his sniffing.
Verdict:
"Doc, you smell pretty good, but I thank it's her right here that I smellt when I got in here. She smell the best." Then he looks over at this other lady and says--I kid you not--"now baby you might need you some more Sure." And he threw his head back and laughed. Then he leaned back over, sniffed her near again, and shook his head."Wheeeeew. Yeah, baby. You got to do somethin' bout that!"
0_0
Wait. Seriously? Seriously.
#6 Tell me how you really feel.
"Good morning!"
"NO!"
"Beg pardon?"
"Get out!"
"Get out?"
"Get out!"
"I need to examine you."
"No!"
"But--"
"I said NO!"
"Okay. Is there anything that I can do for you before leave?"
"Let that door hit you where the good Lord split you."
Well alrighty then.
#5 You probably think this song is about you.
"Can I go home today?"
"I'm pretty sure. We just need to confirm one more thing, okay?"
"Hmmph."
"What's wrong?"
"Manning said I could go. Manning! She's the boss. Call her so I can speak with her about me leaving. You need to call Manning."
"I'm Manning."
"You Manning?"
"Yes, ma'am."
"Oh, damn. I thought I could trick you into getting me on out. I thought you was a intern."
"Thought I was an intern?"
"Yeah, you looked kinda younger."
"And for this reason, I will totally be expediting your discharge."
#4 -- What's in a name?
"You're all set to be discharged!"
"Great!"
"Do you have someone to pick you up?"
"Yes. My lover is picking me up."
"Your lover?"
"Mmm hmmm. My lover."
*all of us laughing together*
"Your lover?" I repeat. "That sounds awesome."
"And baby if you knew my lover like I know my lover you'd know that he really is awesome."
*gives me two exaggerated winks*
Love. This. Place.
#3 -- The Hard Questions on the way home.
Isaiah: "How was your day, Mom?"
Me: "Kind of rough. One of my patients is pretty sick. She might die."
Isaiah: "Die?"
Me: "Well she has a bad illness, so yeah, she might."
Isaiah: "Did you give her some medicine?"
Me: "We've tried but for this kind of illness it won't work."
Isaiah: "Mommy?"
Me: "Yes?"
Isaiah: "Are you sure you know what you're doing?"
Damn.
#2 -- Full Circle.
Small Group Alpha - First year of medical school 2007
Me with Dr. Wetmore, Dr. Nguyen, and Dr. Carlisle in 2011
One of my interns this month is a student from my original small group -- "Small Group Alpha." I've known him since his very first day of medical school. Yesterday on rounds, every time he presented his patients or every single time I referred to him as "Dr. Wetmore" I sort of wanted to cry.
#1 -- I do not speak Spanish.
I have come to accept this. Louder and slower does not turn English into Spanish. Neither does saying "como se dice en Espanol" before every single thing you say. And so. I have vowed to call a Spanish interpreter whenever I have any situation at all where the patient does not have full mastery of English. No using the eight year-old in the room or the clerk on 7A.
On Friday, I went with the interpreter to see a patient and his family. And I did what the interpreters have taught me to do--speak exactly as I would normally speak with pauses for them to interpret. I held my patient's hand, looked him in his eyes, and even cracked jokes. The interpreter slowly faded into the background (which is their goal) and I connected with my non-English speaking patient and his family. It was awesome.
It doesn't sound so deep does it? But it was. It truly was. I realized how many patients I haven't connected with due to a language barrier. It felt so good to wait those few moments for someone to stand in and allow us that connection.
Of course the news was bad. Ever since I was a medical student this was always the old adage: "The nicest patients have the worst diagnoses."
And you were nice. More than nice, really. You were funny and witty and smart and likable. Everything that portends a poor prognosis.
I met you during the honeymoon period before things were confirmed. You patted your bed and told me to sit down next to you which is exactly what I did. You said things that made me laugh out loud. And you knew your medical history like the back of your hand and barely came up for breath when telling me every single detail of it.
"Was that too long?" you asked me.
"Uuuuhhhhhh. . .I mean. . . it was. . . uhhh. . .thorough."
Then we both erupted into big, fluffy hearty laughs at the same time. The kind that float out into hallways and summon others inside. When I asked the next question, I narrowed my eyes and said, "Alright, this time give me the Cliff Notes version."
You furrowed your brown and wagged your finger at me lightheartedly. Again came those big, fluffy, and contagious laughs all over again. Because you were cool like that. Serious about what was going on with your body but cool enough to pat your bed and welcome me into your space. And to make our encounter one that welcomed this kind of humor.
"I feel so much better," you told me.
"I'm so glad you do!" And I meant that. I wasn't there when you were first admitted, so I never saw you at your worst. As much as you stole my heart in just ten minutes, I'm so glad I didn't have to see you that way.
Now, you did look good. Good enough to discharge from the hospital, even.
But. There was still a cloud looming over our heads. Even if you did feel like a champ, your original symptoms and findings made no sense. Unless, of course, it was the very worst thing possible. I hoped so bad it wasn't that. I crossed my fingers because you looked so good. Too good for that word that nobody wanted to dare say but would eventually prove to explain your entire hospitalization.
Cancer.
When I came to see you again, you had already been given the diagnosis. This time I was rounding with the medical students and before going in your room, I told them, "The diagnosis has already been discussed. I just want to go and visit, you know? To just. . .I don't know. . .check in." I stammered a little more because there wasn't some big teachable moment or physical finding I had to share. This was just me going to see a new friend who'd just heard some heavy news. A new friend who happened to be a patient on our hospital census.
When I got in the room, you were your same self but a little less spunky. Our exchange was as easy as the day before, and something about that made my heart hurt.
"I feel like you have some piece of information or like something is going on," you said. "You look like you got something to tell me. You got some more bad news you haven't told me yet?"
And I just stood there staring back at you. You had already recounted everything that every other doctor had told you already. You knew the diagnosis and broke it down far more than I'd ever heard any patient break down anything. So, no. I had no more news. Or anything for that matter.
"No, I have no news." My voice became tiny and watered down. "I. . I just really felt. . . touched by you yesterday. I loved meeting you and talking to you and laughing with you. I guess I kind of felt like we connected."
You sat up in your bed and smiled. "I felt that way, too."
I smiled and added, "So, really, I just wanted to come and see how you were today. With all that's going on, you know? I just wanted to come and see about you."
"I appreciate that," you said.
You patted your bed once more and again welcomed me in. This time with your better half in the chair right beside you who, of course, was just as nice as you.
"Alright, Manning. Now since we connected and all. . .I hope you use some of your connections to get me up out of this hospital!"
And we laughed. Hearty, fluffy, and so contagious that the students joined right in.
And we talked. And connected just like we did before.
Ever since I was a medical student this was always the old adage: "The nicest patients have the worst diagnoses."
Damn. You never stood a chance.
***
Happy Late-Friday-Early-Saturday.
Now playing on my mental iPod. . . my favorite song about connections. . .
It's the first day of March and I'm starting a new month on the inpatient service. What's extra special about this month, though, is that there are other new beginnings. This is the start of the clinical rotations for our second year medical students. Ah, new beginnings, indeed.
I saw some of them yesterday. Standing near the elevators with their teams. Coaching themselves to get the deer-in-headlights look from out of their eyes. But I saw it. And smiled.
That look in their eyes has a little to do with fear. But mostly I think it has to do with respecting human life so much that you want to help and, of course, "first do no harm." And maybe that isn't how they're feeling. I mean, I can only speculate based upon how I felt back then. Something tells me that not that much has changed, though.
Yeah.
A lot of us fight to help them to hold on to that. That sense of wonder, of deference, of awe. Lord knows I fight to have it myself.
So today I woke up and thought about this list of new patients that I'd meet. I read about their problems and reviewed their electronic charts. There were things that I needed to look up because I wasn't familiar with the management or had forgotten it or somewhere in between both of those. And now that I've done that, I'm just sort of sitting here. Letting myself feel that tiny sense of nervousness in the pit of my stomach. Not so much that it makes me deathly afraid. But just enough to remember that sense of deeply wanting to help and, of course, "first do no harm."
These are human beings. These human beings have families connected to them and lives beyond me and my overfull schedule and my little bag of internal medicine tricks. Their problems are real ones. Not pretend ones designed for teachable moments with earnest young students or enthusiastic bedside teachers. No, not at all. They are real and exist in a continuum--not just as points on my curriculum needs.
And so.
I feel those nerves because I just hope to get it right, you know? Every single time I start a month, I let myself feel this. I dig down deep and find those butterflies that somehow get lost in repetition. Feel those same fluttering wings that I know are stirring in the guts of those novice medical students that I see standing near elevators with their nervous dispositions.
Because clinical medicine is not just about conditions like heart failure. It's about heart. One heart at a time. And though that one heart may have the same physiology as the thirteen others on my list, today that heart is relying upon me--upon us--to care as if it were the only one under our watch.
I guess that's something to have butterflies about.
***
Happy First Day on Wards.
And now playing on my mental iPod. . . ."Fear" sang live by the lovely Sarah McLachlan
Honestly? I write this blog to share the human aspects of medicine + teaching + work/life balance with others and myself -- and to honor the public hospital and her patients--but never at the expense of patient privacy or dignity.
Thanks for stopping by! :)
"One writes out of one thing only--one's own experience. Everything depends of how relentlessly one forces from this experience the last drop, sweet or bitter, it can possibly give."
~ James Baldwin (1924 - 1987)
"Do it for the story." ~ Antoinette Nguyen, MD, MPH
Details, names, time frames, etc. are always changed to protect anonymity. This may or may not be an amalgamation of true,quasi-true, or completely fictional events. But the lessons? They are always real and never, ever fictional. Got that?
