The Internship and Residency Chronicles: One thing leads to another.

A replica of the watch I wore for four years of residency.

"Why don't they do what you say?

Say what you mean

One thing leads to another

You told me something wrong, 

I know I listen too long but then

one thing leads to another."

~  from The Fixx "One Thing Leads to Another"

_____________________________________

Summer on the wards, 1998


"Hey! Who am I?"

Kevin, one of my co-residents, grabbed a stack of index cards and tucked them into the waistband of his pants just at the center of the small of his back. Then he playfully lifted up his left arm and began poking his index finger repeatedly onto the face of his watch. Everyone standing around the nurses' station erupted in laughter.

"Ha ha. Very funny," I replied with a playful scowl. I bent my stethoscope in half and attempted to swat his arm with it.

"That's classic Kim Draper on call, dude. Classic!"  Kevin threw his head back and cackled. Then he leaned on the counter with both elbows in front of me. "Patient cards in the back of her pants and that scary calculator watch. Dude! What is it with you and that calculator watch?"

The interns and medical students from both of our teams were scattered all around the nurses' station and work area writing notes and orders-- but weren't too busy to laugh at Kevin's observation. My scary calculator watch had become legendary amongst my fellow residents--especially because I had mastered the tiny buttons so precisely that could get to any calculation in lightning speed. I also stored an unusual amount of data inside of it. No, I wasn't making a fashion statement with it, but for the pre-app/pre-smartphone era, the thing was awfully practical.

I folded my arms and curled my lips. "Look here, Jay Leno. . . half of my time is spent taking care of kids so I need this sucker to be able to calculate doses." I proudly lifted my left wrist and gave a slow, smug nod at the super-geek-ified contraption fastened onto it. With a shrug I added, "You can hate on the big face Casio all you want but all I'm saying is that this scary calculator watch has saved some lives in the clutch. Lives, I say!"  Everyone laughed as I slammed my palms onto the desktop in the most exaggerated way ever.

"Does that thing . . .like. . . glow in the . . .dark?" One of Kevin's interns decided to get in on the fun.

"It glows and projects x-rays, prepares blood smears, and spins urine." I feigned a very serious expression while raising an eyebrow.

"You know the worst part? I saw two other Peds interns with those things on!"  Kevin said incredulously to his intern. He squinted his eyes, stared at my watch again and then shuddered. "Seriously, Kim? Least cool watch of all time."

I stacked my patient cards up on the counter and jammed them straight into my waistband at the lower back, nearly identical to the way Kevin had just mimicked. Next I slung my stethoscope over one shoulder and walked around from the nurses' station with my nose haughtily turned upward and my palm splayed out in front of me. "Talk to the hand, Kev! You know you want a big face Casio, dude!"

Just as we started to joke around some more, both of our pagers went off nearly simultaneously. We were both the senior residents taking call that day, and things were already hopping. Kev unclipped his pager from his scrubs and pushed a button to see the number. He held it toward me and shook his head. "Seriously? Somebody must have ticked off the ER gods. Sheesh! This is my third admission in one hour!"

I pointed the LED screen of my pager in his direction and offered a sympathetic nod. "Same here, man."

"Yeah, dude. . . but at least you have a computer strapped to your wrist to help you." Before I could come back with a witty retort, he was scurrying down the hall toward the elevator.

"Hater!" I called out behind him.

After I watched Kevin disappear around the corner, I turned my focus onto my team made up of three interns and two medical students. Lee, the most efficient and easygoing of my interns, was sitting directly beside Maya, one of the two medical students on our team. In front of him was an EKG that he was carefully reviewing with her. Emily-Ann and Aneesh, my other two interns, were writing what appeared to be progress notes or orders into open charts. The sound of my pager seemed to kick them both up a notch with an added sense of urgency.

 And then there was Camille.

Camille was the other medical student on our team that month and she was. . . . . notoriously special.  Not special in a really good way, unfortunately, but special in the sense that oft times she'd say and do things that absolutely floored everyone around her.

Case in point: There was this one day that Dr. Olds, the Chairman of Medicine, came to join us on rounds (in that way that sometimes Chairs do) and he asked Maya and Camille if they'd like to go down to the micro lab to look at our patient's gram stain.

Now. When a Chairman asks you to go anywhere educationally-related as a student---even if it is to explore the components of toe jam under an electron microscope--there is one answer and one answer only.

"That would be great!"  (Or if you aren't the shmoozy type, "Yes, sir" or "Yes, ma'am" will suit you just fine.)

What was particularly egregious about this, though, was that our Chairman was an internationally recognized tropical Infectious Disease doctor with a wealth of knowledge and experience. A moment at his feet, especially if you were a student and especially if it involved something infection-related, was equal parts awesome and  hard to come by.

But on this day, Camille looked our Chair square in his seasoned, World Health Organization tropical ID nerd, big-boss eye and said with a wrinkle of her nose, "No, thanks."

SKKKRRRRRRRRRRRRRRTTT!!!!! Slam the freakin' brakes!!!

Yes. She really said that.

Not. Even. Kidding. The child had just told our Chairman "No, thanks" as if he'd offered her butter for a dinner roll or something! And I kid you not, she said this like it wasn't anything and went right back to reading the First Aid for the Boards book in front of her.

Dr. Olds didn't even flinch. He simply nodded and gave a terse smile which made me want to jump out of my chair and kick Camille squarely in the behind. (I know it's bad that I felt that way since that's technically violent, but it's true.) So off he went with Maya, who really did want to see that gram stain because she actually recognized what an honor it was to learn one on one from a master teacher and the freakin' Chairman of the whole department of Medicine.

Hello?

See, had that happened today, I would have immediately pulled Camille aside and gave her some swift feedback. But back then, I did what many residents did (and still sometimes do) -- I called one of my fellow residents and cracked jokes about the craziness of my medical student. My partner in crime that month was Kevin.

"She said WHAT?" he howled that day through hysterical laughter. I kept repeating the story over and over and he'd double over with every escalated version. And that was pretty much how that got dealt with. From that point forward it was understood that Camille was. . . . uhh. . . special.

"Got one for me?" Lee asked while looking up from the EKG that he was reviewing with Maya. He had already finished his morning work and was availing himself to another patient.

"Not sure yet," I replied while dialing the number back. "I'll let you know in a minute." Just then someone answered the phone in the emergency department. "Good morning. This is Kim Draper, 9B senior. I was paged?"

After being placed on hold, an ER resident friend of mine came back to tell me about the next patient being admitted to us. As she finished telling me about this middle-aged fellow with heart failure, she then added, "Don't kill me but I actually have another admission for you, too."

"Ingrid! Y'all are killing us!" I groaned.

"Dude, you should see it down here. It's mayhem, dude." (I have no idea why we insisted on all calling each other "dude.")

"I know, I know." I pulled a blank card from the stack tucked in my waistband. "Okay, I'm ready. Hit me."

So Ingrid then told me about this other patient who interestingly was also being admitted for a heart failure exacerbation. This wasn't a surprise; everyone knows that diagnoses often come in groups. This was obviously "heart failure day."

"Everyone is ignoring their low-salt diets and eating barbecue, I guess," Ingrid added at the end. "I've admitted four people today with volume overload. I'm not kidding."

"Crazy!" I responded while balancing the phone on my shoulder and sorting out my cards.  I flicked them out into stacks by intern like some sort of dealer preparing a hand of blackjack in Las Vegas. "Thanks, Ing. Anything else?"

"Naaah. Sorry, dude."

"No worries."

I hung up the phone and looked up at Lee and Maya.  "Maya, how about I have you pick up this gentleman. Lee, you can take him with her." I handed the card to Maya. "Mr. Allen -- a fifty-seven year old man with shortness of breath who can't lay down flat since yesterday."  Maya perked up and nodded eagerly. Lee waved for her to follow him and they leaped straight into action.

Emily-Ann had already received two admissions that morning so she was off the hook--at least for the moment. Aneesh came beside me and positioned himself to take the next patient. Camille, on the other hand, continued to quietly read her First Aid for the Boards book in the swivel chair behind us.

"Emily-Ann, you'll be up next. Aneesh, you guys can pick up Mrs. McIntyre here," I said, stating the obvious. Emily-Ann nodded and kept writing in the chart and Aneesh reached for the note card with Mrs. McIntyre's information scrawled on it. "Lots of swelling, shortness of breath, and hasn't been compliant with her Lasix or her sodium restriction. Ingrid said her ejection fraction is only 20% and she's followed int he Cards clinic."

"Gotcha," Aneesh responded while jotting down information onto his own note card. He asked a couple more questions which folded us into a conversation about heart failure management. Half way through my response, I looked up and realized that Camille hadn't budged.

"Camille? Oh my bad, how about you come over and hear this, too, since Mrs. McIntyre is going to be your patient with Aneesh. She sounds like a great patient!"  I smiled tightly, clenched my jaw and told myself to assume the best of Camille. Yes, I was annoyed that she hadn't thought to get up and join us and of course, some part of my foot still wanted to kick her squarely in the caboose. Coaching myself to not show exactly how irritated I was, I took my card from Aneesh and extended it toward Camille like some sort of olive branch. "Here, you can just take my card with the info on it. I'll make a new one."

Camille didn't move. She looked up from her book and offered a quick, tightlipped smile. "No, thanks," she answered nonchalantly. "I'll just wait for the next one with Emily-Ann."

Wait, huh? 

I stared incredulously at Camille who had already returned to licking her finger tip and turning the pages of her study book. I laughed nervously. "Uhhhh. . . yeah. Camille, it wasn't really an optional suggestion. I want you to pick up Mrs. McIntyre."

She furrowed her brow at me in a way that I felt rather like she was blowing off what I was saying. Still holding the book on her lap with both hands, she gave that same dry smile. "It's okay, I can wait."

What the?

That's when she said one of the craziest things I have ever heard. "Look, I don't even want to do Internal Medicine. It's so . . . .redundant. The same things over and over again. Since I have to take an admission at least I can wait for something cooler to come in."

Whaaaaattt?

Aneesh widened his eyes in my direction and Emily-Ann froze while waiting on that chart. We all offered an obligatory pause, just to see if she was joking even though we knew full well that she wasn't.

"I bet Mrs. McIntyre thinks that she is cool." That was all I could think to say that didn't involve expletives. Plus, I wasn't as savvy with medical students as I am now.

Camille snorted and replied, "I bet she does. How 'bout I go down there and just tell her to not eat pork skins and take her Lasix? I can do that and be back up here in five minutes."

Oh my good golly Miss Molly! This child was dead serious. My mouth fell open as did those of my interns. Before I could even respond, my pager went off again. Camille returned to her book. I willed myself to not be as mad as I was starting to feel but it wasn't working. I focused on my pager and the call that had just come in.

It was the ER again, this time with a seventy year old gentleman with -- you guessed it -- shortness of breath. It wasn't clear if this was emphysema or heart failure or both. Camille listened to the exchange and didn't even bother to hide the eye roll she made as I hung up.

She cannot. Be. Serious. Take a deep breath. Deep breath.

Emily-Ann instinctively took the information from me and paused to see if I had anything to add. "He's in the ER on the B side," I told her.

"Anything else?" Emily-Ann queried.

"Nope. I'll be down shortly." I glanced over at Aneesh. "Hey, Aneesh? Go ahead and see Mrs. McIntyre and page me when you're done. I'm heading down to see Lee and Maya's patient and I'll catch up with you after that." I slid off of the chair and restacked my cards once more. Back they went to my waistband as I stuffed my feet into the clogs that had fallen on the floor in front of the chair. I could feel my blood boiling.

Be cool. Be cool. Be cool.

I yawned a very fake yawn and decided to remove myself from that situation.  Camille had infuriated me so badly that I couldn't even deal with her. So, in that instant, I decided that I would not. As I walked past her she whipped her head up from the book and looked puzzled. "Kim? What do you want me to do? Come with you or what?"

"Nope. Definitely not that."

She squinted one eye and sighed. "Uuuuhh, okaaaaay. . . .soooo. . . .what should I do now?"  Her response was laced with sarcasm and had this trivializing tone to it.  It pissed me off even more.

Calm down. Relax. Be cool, Kimberly.

"How about this? How about you go home and read your book. It would be far more comfortable for you and it's not like you want to do Medicine any way." Steam was steeping out of my ears.

"Excuse me?" Now she was serious.

"Go home. I'm serious. Nothing cool enough for you is likely to come in today, so leave. Go." I flicked my fingers toward the door in case my words didn't convey what I meant. And with that I walked down the hall before it got any uglier. I could feel my pulse quickening as I walked away. I didn't care what she did. I was there to take quality care of patients. Anybody who wasn't down with that could go somewhere, anywhere -- just away from me. It was like that old saying goes, "You ain't got to go home, but you got to get the hell up out of here!"

I guess she could tell that she had messed up at this point. By the time I reached the elevator and started aggressively pushing the button to go down to the ER, Camille had appeared beside me.

"Gosh! I'm sorry, okay? Fine, I'll go and see the heart failure lady with Aneesh. Where was she?" The way she said "sorry" was nasally and cynical. And the way she referred to Mrs. McIntyre as "the heart failure lady" took me somewhere out-of-body-ish.

That did it. I had tried to get away from her but this was the last straw.

"GO HOME. I mean it. LEAVE. GO." I felt my voice crackling a bit. "Take your book and your funky attitude to the coolest place you can find with the coolest people you know. I don't care WHAT you do. Just do it away from me. I really, really mean it. GO!" She stepped backward like she thought I was planning to hit her. And while I'm not a hitter or even the fighter type, I have to admit that I'm not fully sure that hadn't crossed my mind for a millisecond.

"Just because I am not all 'ooh aaahh' about Internal Medicine doesn't mean I'm a horrible person. I'm just honest unlike the rest of these medical students around here!"

"No, Camille, unlike the rest of the medical students around here, you're an asshole. An entitled, disrespectful little asshole." That boiling blood had now turned to vapor. The elevator seemed to open at the most dramatic time. "Now please. Get away from me. I'm dead serious. Get out of my sight--please." I took in a deep drag of air and swallowed hard.  She just stood there frozen and I cocked my head at her angrily. "Camille, move out of my way so that I can go and take care of my patients. The last thing I want is some ungrateful asshole around my patients."

I stepped past her hard and onto the lift. My eyes were stinging with angrily confusing tears and my head was hurting. Knowing that I was near tears made me even madder. I couldn't reel back my emotion; I felt like some kind of drunken person. I clenched my jaw and waited. The last thing I saw was her now crimson face as the doors closed.

In the silence I immediately began to think. And feel regret.

Wait. Did I just call my medical student an asshole repeatedly and send her home? Did I?

Indeed I had.

Immediately, I felt ashamed. I knew that Camille wasn't right, but I also knew that my response wasn't either. I tried to lose myself in patient care for the next few hours, but couldn't stop worrying about my inappropriate outburst. Eventually, I found a quiet bank of phones on one of the wards and called my attending physician, Dr. Blinkhorn.

He listened intently as I explained everything that had happened. And I'm not sure why, but I began to cry while I was telling the story. Unusually hard, actually.

"Where are you?" he asked.

"On 10B," I quietly answered.

"Wait there. I'll come to you," he instructed me.

Less than five minutes later, my attending arrived and walked with me over to one of the patient waiting rooms.

"I'm glad you called me, Kim," he said as an icebreaker.

"Sir, I don't even know if she went home. I was just. . .so. . .so mad at her. For being so disrespectful, you know? And when she disrespected Dr. Olds it was. . . I don't know . . .funny to me. But today the way she disrespected our patients--especially the one I tried to give her---it just . . .took me someplace else." I plunged my hand into my hair and pressed my lips together. Now my eyes were mounting with tears again and my face was growing hot.

"What time did you go home yesterday?" Dr. Blinkhorn asked.

I shrugged my shoulders.

"You seem tired."

Like a toddler, his "tired" accusation upset me even more. Those tears pushed straight out onto my lashes again. "I'm not tired, sir. I'm mad."  To offset my emotion, I reached into my waistband and nervously thumbed through my patient cards.

He nodded in concession and backed off of that.

I shook my head and then added,"You know? I don't even want her here if she doesn't want to be here, Dr. B. I mean it."

Dr. Blinkhorn looked over at me wisely and placed his hand on my shoulder. "Kim, you know what I know about you? I  know that you are a leader. And as a leader you have to lead all kinds of people. All kinds. Some will follow your lead willingly, others will not. But a good leader leads them all."

I wiped my face hard with the heel of my hand and stared back at him intently.

"Your job is to make them want to do what they don't want to do. You can't let them see you losing your cool like that. You can't." He paused for emphasis. Then he went on. "You also have to pay attention to yourself. Make sure you aren't so tired that your fuse is short. The same way you take care of these patients, Kim, you have to take care of your team and especially yourself. You have to."

That's when it dawned on me that I had never really thought about it that way. I always thought my job was to take care of patients and patients only. But my team and . . .myself? That had never even occurred to me.

I thought that being patient-centered was all that was necessary. I even had a scary calculator watch to calculate things for my patients. To double check drips and dosages and to quickly pull up numbers to expedite things for them, my patients. I kept meticulous track of every one of my patients with that giant deck of index cards and color-coded every last one of them with a highlighter, too. Because, for my patients, the love was in the details.

But my team? And me? This wasn't even an afterthought--it wasn't a thought at all. Our job was to come in and care for these patients with all of our might. Period. End of story.

Yes, my student was rude and disrespectful. But then, so was I.  I was also tired and overworked and overstretched. When she finally broke the camel's back, I lit straight into her like a bat out of hell. One bad thing had led to another. And this wasn't effective leadership at all.

Suddenly I deeply wished to fix this but realized I may have missed my opportunity. "I sent her home, sir. I told her . . to leave."

"Now come on, Kim. Do you really think she left at 10:30 AM on a call day? I ran into her crying near an elevator."

Eeek. 

"So you already knew what happened?" I pressed feeling even more ashamed.

"Somewhat. And I did talk to her about professionalism and my own concerns. It's only fair to tell you the same."

I nodded hard while still watching him. "Yes, sir."

"Your goal as a leader isn't to make her cry. It's to get her do do the right thing. Yelling at her and calling her an asshole probably won't achieve that, you know?"

"I know."

"All that does is make the issue snowball into bigger issues. Go and talk to her. And say what you mean. Like a leader, Kim." He kept his eyes focused in on my own. "And then, go and get you some rest if you can."

Later that afternoon, I found Camille and talked to her. I apologized for calling her names and explained how I felt. I shared with her how frustrated I had felt and how disappointed I was in her for the several things that I'd witnessed that month. Then I told her how disappointed I was in myself for snapping like that.

"Seeing how upset you were kind of woke me up," she said. "I guess it made me realize how offensive I'd been."

"Yeah, but I still shouldn't have gotten so upset. I'm sorry."

"I'm sorry, too."

Then she told me all about the month she'd experienced before ours where she'd been ignored by her resident, attending and interns. She described how her resident scutted her all about and seemed disinterested in her or any other student on the team. This was a sharp contrast to her month on the Ob/Gyn service where every member of the team worked hard to include the students.

"It seemed like you already had an opinion of me early on," she said. "Like you were mad at me or something. I guess I felt mad, too."

I thought about that for a few seconds and realized that she was right. I had talked about her like a dog behind her back to Kevin not even two days before. Described her with words like "ridiculous" and "ultra-entitled." And never once had it occurred to me to sit her down and explore why or even discuss any of this with her.

"Camille, let's try to start over. There's still a few weeks left."

And she agreed and promised to have a better attitude. I believed her.


Today I am reflecting on all of the working parts that make team-based patient care work. The things we use to keep track of our patients, their medication doses and their progress. . . .how the work is distributed. . . but especially the team. That day, I learned one of the most valuable lessons of my career. I learned that the most effective leaders--especially in medicine--are able to take the most excellent care of their patients because they also take care of their team and themselves.

They listen. They pay attention. They reflect. And they make the necessary adjustments. All of this has to be done with careful intention.

Falling apart and hollering? Uhhhh, not so helpful.

By the end of that month, our team was a well-oiled machine. The interns and everyone else treated Camille kindly--and I know this is because they saw how I was now treating her. And even though I didn't change her mind about a future in Internal Medicine, I can honestly say that by paying closer attention to myself, I was more able to bring out the best in her. I truly was.

She even went out and bought herself a big face Casio watch just like mine and wore it faithfully. (Okay, maybe that part is an exaggeration, but it sure would have been a nice way to end the story, right?)

Yeah.

It's more than ten years later I've grown up quite a bit. I no longer wear that scary calculator watch. Nor do I stuff index cards into my waistband. You know what else? I also don't spend more time talking about my learners to other people than I do talking to them. That's proven to be far more effective.

But the biggest difference? Now, before I focus on anyone else, I take care of myself. And that has proven to be one of the most effective leadership lessons of all.

“What makes leadership is the ability to get people to do 

what they don’t want to do and like it.” 

— Harry Truman

"Not the cry, but the flight of a wild duck, leads the flock to fly and follow.” 

– Proverb

***
Happy Hump Day.

Now playing on my mental iPod. . .


*with the exception of my Chair and attending, all other names were changed.

Love, Eggs, and Latin Phrases.

*Caution: Non-medical Easter ramble ahead.*

Res ipsa loquitor: Latin phrase meaning "The thing speaks for itself."

______________________________________

Hey! Happy Easter! And let's just start by considering this a "Happy Easter" in the general sense. Not in the "I'm of Christian faith and you're not" sense. So yeah. Happy Easter!

Look. Before somebody gets mad at me, NO this doesn't mean that I am trivializing the importance of this, our holiest of holidays. Note that I said "our" and not "your." Unless you're new here, you probably know already that I am indeed of Christian faith.

No. This does not mean I have any fire or brimstone to throw at you, so relax. That's just not my thing (or my interpretation of my own faith.)

You know?  I see (religious) faith as a very personal thing. But not "personal" in the sense that it's secret or off-limits. . . but instead in a way that's my own responsibility to understand and live without suffocating others or making them uncomfortable. Yes, I'll talk about it but carefully and respectfully --kind of like my political beliefs and such. Mmmm hmmm. Like that.

Anywho.

Where was I? Oh Easter. Easter in the non-general sense is important to me. For me, it's a time of quiet reflection and counting blessings. Even if I'm hustling and bustling to and fro to early morning Son-rise service or whatever it is that day, at some point I always escape to some serene place in my mind to be in the presence of all that frames my personal relationship with my faith.

This year, my quiet time led me to that photograph above. A beautiful sunrise over the ocean is a perfect reminder of all that Easter Sunday and the days leading toward it mean to me. A soft light that welcomes me but doesn't feel blinding or oppressive. This is how I see my personal relationship with God and my faith.

Especially at Easter.

Right before Jesus prepared to leave the disciples, He told them that He'd be going to a place they couldn't follow Him to. Then, as if that weren't enough, He stated what He described as a "new commandment." And it was rather simple, and frankly, not so new-sounding at all:

"Love one another."

Say what? 

Of course the disciple-dudes first balked at this whole departure announcement and this not-so-new-under-the-sun sounding commandment of His. I bet they were all like,  "Love one another? How whack is that? What about click your heels three times before entering all rooms that have running water or balance on one foot every single time you pray for now on? Love one another? That's all? Plus, how will people know we're down with you if we can't go with you? Man, it's VIP being with you!"

So yes, they balked. And when they did balk, Jesus went on to let them know that they didn't have to be physically with Him to be with Him.

So Jesus goes on and says: "Look, y'all. If you want people to know you're down with Me, no need for a 'Jesus is my Homeboy' t-shirt or a giant flaming bible. All I mostly want y'all to do is to love one another. Or better yet, just treat people as I have treated y'all."

Mmm hmmm. Sure did.

Okay, maybe Jesus didn't say "y'all" but I do think if He'd been somewhere in the Southern United States He wouldn't have been above it. And see, that's my personal take on it from my personal relationship which, now that I think of it, makes me fully okay with my Miss Manning Real Talk Translation of more than just this scripture.

Yep. (I bet my translation would be quite an easy read now that I think of it.)

Anyways. Just like that sunrise and it's pleasing glow,  I want my light to shine, too. I guess what I want to do is mostly remember what Jesus sprung on the disciple-dudes after that last supper by letting my light shine. I want it to shine bright and warm -- illuminating things around me and drawing things closer but not blinding them or forcing them to shield their eyes from it being too intense. Yeah. A nice light. . . .  soft enough for someone to see it and not be afraid, especially in the darkest places. And also sustained so as not to fully confuse those who see if from far away.

Which reminds me: strobe lights have always kind of given me headaches. Just stick that idea on a post-it note and come back to it later.

Pleasing, dependable, and sustained light. Kind of like that sunrise.

It's unfortunate that so many people spend more time focusing on what others are doing than just loving people for who they are. I admit, I have my days, too. Pointing out splinters in eyeballs and ignoring the plank in my own. But you know? Then I remember--if I just stay in my own lane, remember that new-ish commandment, and work on strengthening my personal relationship with God, that takes up so much time that I don't have any opportunity to go judging someone else.

Which reminds me: I turned on a television and heard someone angrily fussing about the Easter bunny and how awful it is that a CHURCH somewhere actually had sponsored AN EASTER EGG hunt. Because CLEARLY Easter is not EVEN about a mythical bunny or pastel-colored dyed eggs!

Oh relax already.

See? This is where I recoil into my personal relationship again. Chatting the Lord up in the very way I chat most highly familiar folks up. (Some of my best chat-ups are in my car, but I digress.) So I say: "Seriously? Like really Lord? Dying eggs and chocolate bunnies? This cannot be what You are worried about, is it? Wouldn't you rather see us teaching our kids about accepting people or rather imagine us thinking of ways to love one another? I just have to believe that's where You're at with this."

Plus, I was on my iPad in the passenger seat as the BHE drove us home from the beach and during that time, I read my friend Elizabeth's recent blog posts surrounding Easter. And on those posts she was showing photos of her family dying eggs and even today talked about how complicated faith can leave us all feeling sometimes. This, I liked thinking about more than whether or not the Easter bunny is the devil or if  dyed eggs are little orbs of blasphemy. Plus, I know for certain that you would be hard-pressed to find a person more ferociously loving than Elizabeth -- even on your very best day in a very gigantic room full of ferociously loving people.

Oh, what was my point? Other than the fact that Elizabeth is rad, it's that if SHE is dying eggs at Easter time then I at least feel fine about it on my end. Also my friend Kris R. who lives in Uganda gave her kids Easter baskets all the way in Africa today and she is a Faith-sister of mine who teaches me constantly about what it means to have a personal yet imperfect relationship with God.

Yeah.

So to me, I guess Easter is about love and grace and mercy. It's about keeping promises and making sacrifices without a whole lot of grumbling and lip. It's less about words than it is about deeds which is really what I think Jesus was trying to tell those worried disciples that day.

"Dudes! Res ipsa loquitor!"

And okay, I doubt Jesus addressed the disciples as "dudes" or especially "dudes" coupled with some Latin but just like that Latin phrase means -- The thing speaks for itself. In other words, sometimes, you just have to be quiet and let the thing(s you do) speak for themselves. And if moving a ginormous boulder out of the way of a tomb doesn't make talk cheap, I don't know what does.

Mmm hmmm.

Kind of like love. You can talk and talk but if your actions don't say love? Forget it. You can swear up and down to patients that you care, but if your actions say rushed and don't-give-a-damn, forget about them thinking that, too.  And forget anyone buying any part of what it is you call yourself representing--faith-wise or caregiver-wise.

Yes. I am a follower of Christian faith. I am a lover of people. I am a lover of life. I am a lover of God. And I am a work in progress. . . .trying my best to perfect my own light by letting my actions and heart speak for me.

Being a Grady doctor is just one part of that. Being a mother and a wife is another. But all of those parts -- every last one -- require grace and mercy, don't they? Not just from me but from everyone else, too. They also require making a few sacrifices without a whole lot of grumbling or lip.

Yes. My faith is personal. But, no, it isn't a secret. And even with personal differences there's room for us all here. At least, I think that would have been Jesus' take on it then and now.

So today, I am celebrating sunrises and a Son rising.  And no, I didn't get a chance to dye eggs, hide eggs or buy chocolate, but I'm okay with those who did. I sure am.

Maybe you aren't celebrating Easter like me or even at all. And that's cool, too. As for me? I am celebrating Easter. As far as my personal faith-relationship goes, what that really means is that I'm celebrating love -- and I hope and pray that, on most days, the thing speaks for itself.

***
Happy Easter.

"A new command I give you: Love one another. As I have loved you, so you must love one another."


~ John 13:34 - New International Version


"Real talk -- I need y'all to quit tripping and do this simple thing I'm about to tell y'all: Hold each other down! See how I treated y'all  and held y'all down even though you were raggedy tax collectors, murderers and total traitors? Yeah, Peter. I'm talking to you.! I'm saying. This is how I expect y'all to treat everybody. For real."


~ John 13:34 - Miss Manning Real Talk Version

Now playing on my mental iPod. . . . .perfect and beautiful.

Kayaks and Cousins and Sunsets, Oh My!

 

****
Happy Spring Break.

I now pronounce you.

"Work is love made visible."  ~ Kahlil Gibran

This day was a regular day at Grady for the most part. Regular in that I had the regular things on my agenda like rounding with my team and signing the charts and looking things up that I didn't know or couldn't remember. I was sitting at the nurses' station reviewing data on the computer. Sitting in a place that is really a "nurse only" place but that the nurses graciously allowed me to occupy. They knew I was just killing some time.

I stared at the computer monitor and mindlessly scrolled through the lab values. Kidney function: abysmal. Sodium: the highest I'd ever seen. I wiped my hand over my face and then looked over toward her room. I pictured a phlebotomist fastening a tourniquet around her swollen arm and plunging a needle deep into the crook of it to get that blood. For what? These results would not change our plans or alter the outcome.

"Why did we get labs on Mrs. Cafferty this morning?" I'd asked on rounds earlier that morning.

"She's a full code, Dr. M," my resident responded while making careful eye contact with me. I liked the way she spoke up before her intern could get uncomfortable about my direct query.

"I know she's a full code," I replied, "but there is not a single lab test we can order or respond to that will change what is happening." Our eyes were still locked.

"But Dr. Manning she's still our patient. She is here on our service and under our care. Shouldn't we still be doing the same things for her as the rest of our patients?"

I moved my eyes from my resident to the rest of the team. They were shifting nervously from the chutzpah of the senior resident's responses.

I asked myself that same question:  Shouldn't we still be doing the same things for her as the rest of our patients?

But she wasn't "the rest of our patients." She wasn't at all.

This was different--and difficult because we had grown to deeply care for Mrs. Cafferty. She'd been admitted to our team three separate times that month, all for complications of her severe refractory leukemia. Entering her eighth decade, her body had run out of fight. Four full rounds of hell-atious chemotherapy with nothing but nausea, horrid exhaustion and frighteningly awful anemia to show for it.

And yes, at the time of that discussion she was still a "full code." This meant that her family wanted every single heroic thing done on her behalf, despite her dismal prognosis.

But still. Even if she was indeed a "full code" that didn't change the unfortunate reality. Mrs. Cafferty was dying. Especially on this, the worst of all of her admissions to date, there was no disputing it.

"Mrs. Cafferty is dying."

 I stated the facts and left it at that. In silence, it set in. I could see their wheels turning. Imagining those same things that I was thinking like, Why are we sticking her with needles and pricking her fingers for blood sugars when those things hurt? Why are we not focusing on keeping her as comfortable as possible? What are we doing?

We entered her room that morning and I stood by as my resident eloquently discussed all of these things with the family. By this point, Mrs. Cafferty was lapsing in and out of consciousness, so this conversation took place with her children. And no, this was not the first time that the subject of end-of-life care had been brought up with them, but it was the first time they were ready to accept what was happening.

"Let her go in peace," the eldest daughter finally said. "This is our decision. Mama would not want us to keep her alive this way. Please just keep her comfortable." The rest of the family nodded in somber agreement.

It was a big family, too. Big and close and keeping close vigil at their beloved matriarch's bedside. So there was a big crowd there when that decision was made. People sitting on chairs and leaning against walls. Teenaged grandchildren nestled tightly into bedside chairs together and even one sitting right beside Mrs. Cafferty in the bed.

By the time I was sitting at the nurses' station scanning those futile lab results, it was early evening. Our interns had finished up and were gone for the day and the resident was probably on her way home after clinic.

And me? I was just sitting in that nurses' station waiting. Waiting for Mrs. Cafferty to die.

Around lunch time she had crossed into a different physical state. That state with agonal respirations and deep, gurgling sounds representing entry into the home stretch. Like thunderous hooves of horses at the end of a race; I'd been doing this long enough to know that it was only a matter of time before she crossed the finish line.

More and more family arrived. They must have heard those hooves, too. Galloping hard, fast, closer and closer. They all wanted to be there to lay the blanket of roses at the very end.

"Dr. Manning? I think. . . .I'm pretty sure she's gone."

That's what that elder daughter came out of the room to tell me. Her eyes were red and tired. She made no attempt to wipe the tears from her cheeks. Her lip quivered when she said that last word: "gone."

I looked up from that screen and froze on her face for a minute. Next, I abruptly stood and came around to face Mrs. Cafferty's daughter.

"It was peaceful," she said with her lip still trembling. "She's. . .she's gone. . .gone home." And with that word "home" she began to cry full on. Hard and sorrowful cries but still restrained.

Instinctively, I hugged her. Tight and hard, pressing my fingertips into her back without saying a single word. I'm so sorry, I was thinking. Do you know? It was an honor to care for your mother. This is what I wanted that hug to convey. I hope it did.

The next part is that part I've never liked. Pronouncing the patient dead. Ever since I was an intern, this has always filled me with angst. Particularly when it has to be done with family watching. The finality of it all; it has always been different than a conversation about the theoretical or even inevitable end of life. Pronouncing someone dead is concrete and unwavering; it's never open to interpretation or with even the finest trace of hope for something miraculous to change it.

Yet this? This is what I signed up for. And I had a relationship with this family so I knew it would be best for them all if I stayed in that seat at the nurses' station until the moment came. I didn't want it to be a stranger or the cross cover intern on call. At least if I could help it.

When I entered the room, it was like coming into a wake. Confluent weeping and sniffling created the ambient noise with the exception of one big, grown man crying a muffled, guttural sound into the fold of his elbow.

"I'm sorry for your loss," I spoke quietly. After pausing for a moment, I approached Mrs. Cafferty. She looked like she was sleeping more than anything. Like Sleeping Beauty, peacefully and quietly sleeping.

I placed my fingertips on her carotid pulse and waited for what I knew I would not feel. After feeling no pulse, I flashed a penlight quickly into her pupils to look for a light reflex. None. It was official. Mrs. Cafferty had expired.

Glancing at my watch, I noted the time--6:23 PM. Though it should have been the furthest thing from my mind, I immediately thought of how happy I was that this was a Tuesday. Had it not been, I would have already been gone to get the kids. Tuesday is the day that my sister, Deanna, picks up the boys so I put thanking her for that on a mental post it note for later.

"Dr. Manning, we appreciate what y'all did for Mama." This was what one of the younger ones in the room said. He looked to be in his late twenties or early thirties, but I really couldn't tell if he was a son or a grandson. I nodded in return.

Next, that same elder daughter extended her hands outward at her side which I quickly learned was a signal that the entire family recognized. They all formed a giant horseshoe around Mrs. Cafferty's bed that became a circle once the two people on each side of the head of it each placed hands on their sweet loved one's respective shoulders. Before I could even react, each of my hands were already tightly encircled by family members--one was a teenager that I'd seen earlier and the other was that same spokesperson daughter who had now become the new matriarch.

"Every head is bowed, every eye is closed," she instructed, "Let us pray."

And that is exactly what she did. Or rather what we did. We touched and agreed and acknowledged the life of someone I had known for only three weeks, but whose life unfolded before me with every word. Having my eyes closed helped me to see it all the more clearly. . . . what love can do when applied consistently.

We said "Amen" and then someone began to sing. Soft at first but then stronger and stronger. A gospel song that I didn't recognize, but one that must have been one of  Mrs. Cafferty's favorites from the response it garnered. Hands raised toward the heavens, more weeping, tight hugs gripping with grief.

Then, it was all over. People began spilling from the room with arms slung over shoulders. Nurses offering condolences and hugs. And me sitting at the nurses' station again, this time writing a death note.

I finished up, drove home and told every single member of my family how much I love them. And I also thanked my sister.

And yes. This? This was just a regular day at Grady. Regular in the sense that it was perfect and meaningful and full of grace.

***
Happy Good Friday.

And the winner is. . . .

The First Annual Sand Sculpture Thingie Competition 

Team Octopus: Fran, Jill, and Corey. Team Captain: Auntie Fran

Team Mermaid: Grandma, Olivia, Erin, Chris, and Kimberly - Team Captain: Grandma Shug

Team SpongeBob: Uncle Will, Gabby, Lauren, and Rob Team Captain: Uncle Will

Team Sea Serpent: Tyler, Heather, Hanna, Meg Team Captain: ?

Team "We Don't Know What It Is Yet": Isaiah, Zachary and The BHE. Team Captain: Isaiah.

"What is it, Isaiah?" "It's like a thing with a big fortress thing around it."

Well? Who's your winner?

***

(Spring) Break Out.

 

Don't stop to ask

now you've found a break to make it last
You've got to find a way
Say what you want to say
Breakout

Some people stop at nothing

if you're searching for something

Lay down the law

shout out for more

breakout and shout

day in and day out - breakout

breakout !

~ from Swing Out Sister's "Breakout"

_________________

Monday:  Late night flight out to San Diego for the Society of Hospital Medicine Meeting.

Tuesday:  Gave two talks at the SHM meeting. Well, one was a workshop, but you get the picture.

Tuesday afternoon: Almost moved to tears by kind comments posted on this blog. (Thank you so much.)

Tuesday night:  Red eye out of San Diego.

Wednesday morning: Back to ATL.

Wednesday lunchtime: In the car with Team Manning headed to the beach.

And now:  Good times with family--cousins, brother, sister-in-law extraordinaire, good friends and the ocean. 

A whirlwind of a breakout, yes. But worth it. So very.

***
Happy Spring Break, y'all.

Now playing on my mental iPod. . . . .

Breakout／Swing Out Sister by gaimon5656

Clotheslines and vulnerability.

On many days, I'll write something and get so into it. So into that I swear it feels like I'm reliving the experience. I'll ruminate over the details like how someone moved their hands or even the tiniest descriptions because I need that for the picture to be complete. Once I finish, I read it and then reread it. Then I'll laugh or cry or think or just sit in silence. And a lot of times I'll wonder how someone else felt when they read it, too.

This morning I was reading my friend Sister Moon's blog and smiling as she talked about hanging clothes on her clothesline--only to have to take them right down because the lawn was getting mowed. I smiled because of the community the internet creates--one where I can hear all about Sister Moon and the dust kicked up from the Mower-Guy. I have never hung any clothes on a clothesline. Or anything for that matter. Then again, maybe I have hung a few things out there. This blog is a bit of a clothesline, wouldn't you say?

This morning I was just thinking to myself. . .sometimes it feels a little funny to hang your emotions and thoughts out on that metaphorical clothesline. Your deepest feelings waving in the wind like unmentionables clipped on with clothespins. Moments of your life and the lessons nestled inside of it all at risk for getting covered with the Mower-Guy's dust.

It's kind of vulnerable sometimes.

Hearing from people sometimes takes a bit of that angst away. Sometimes.

You know what? Yesterday I read this post on a fashion blog that I read sometimes. It was literally a few sentences about a pair of strappy sandals and a sundress followed by several pictures of the author modeling them both. Within twelve hours it garnered 90 comments. Wow.

And at first I was like, "Really?" but then the more I thought about it the more I realized that this fashion blogger was hanging a bit of herself out on that clothesline, too. One thing she has to know for sure by now though is that those sandals were a good choice. Ha.

What am I even talking about? I don't know. I'm actually sitting in a hotel lobby at a medical conference. I'm waiting around and using the insanely expensive WiFi I paid for up until the last minute before I have to go and give my two lectures. Well, one is just a workshop and the other is a lecture. Hell, you get the picture.

Anyways. I hope you can see how much of my heart I put on that clothesline. I just want us to think and feel together and to be a bit of an empathic community of sorts. That's my goal.

I know, I know. Many of you are silent readers. I see the traffic which is steady and telling; somebody is reading and then coming back. And I appreciate that. But sometimes? I'd love to know what you think. I really would.  Not necessarily every day. But sometimes.

I'd probably be weirded out by 90 comments in 12 hours. In fact, I know I would. So on second thought? Just consider this a pathetic ramble. 

Oh and don't worry. I love writing enough to do it no matter what. But today? This has just one of those vulnerable days, that's all. 

***

Another Match Day Moment.

These pictures were sent to me by a student that I've had the pleasure of advising for the last two years.  This lovely young doctor is Ania L. -- and she is as beautiful on the inside as she is on the outside. On these snaps, I'd just learned that she had gotten her first choice of residency programs and I guess someone was there with a very nice camera to capture it all. (I'm such a dork when I'm excited. . .ha ha ha!)

When we first met, she was pretty sure that she wanted to become a surgeon. We worked together for a full month at Grady and it was wonderful. (Check her out on the right margin -- that was from our month together.) Anyways, I was elated to learn after our month that she'd changed her mind and decided to pursue a career in Internal Medicine! And no, I don't think it was because of me--duh! But I am so, so happy that I wasn't a hindrance to her coming to that realization (which can and does happen if some parts of the experience aren't good.)

Ania isn't in one of my small groups. But she is one of mine. Totally. I told another student advisee just the other day (who isn't in my small group) -- "When you meet special students, you hold on and don't let go. Next thing you know, you look up and you have a whole collection of wonderful mentees. This is the best part of mentoring." And that's so, so true. We get to listen and teach and advise and assist. We also get to celebrate big moments like this one because once we hold on they become our moments, too. They sure do.


Seriously? This is the best job ever. 


Ever.

***
Happy Monday.

Love, Lake Erie, and Lessons Learned.

Cleveland, Ohio on Lake Erie.

When I started my internship back in 1996, I was new to Cleveland, Ohio. Because I hardly knew anyone there, I pretty much went to work and went home every single day. Occasionally, I would join my co-interns for meals or drinks or even rollerblading in the park. But other than that, my personal life wasn't too exciting.

This was fine because internship is hard. On most days, I'd go home and crash on my couch in front of my television. But there was this one month I had that wasn't too strenuous and I began to realize how blah my life outside of the hospital had become. I told myself that I really needed to "get out more" and"meet more people" so I dug through a drawer and found a scrap of paper that a friend had given me prior to my move there. It was the name of one of her "good friends" who was one of those people who "always knew where the party was." Now most of the time when people suggest such things to me, I pretty much smile and say, "Oh sure, okay" -- knowing deep down that I will never ever call or email or whatever they are suggesting.

But this was Cleveland, Ohio and I wasn't from there. I was officially desperate.

Now. Before any of my Cleveland friends give me the hairy eyeball for that statement, let me just digress for a bit and say a few things about my observations of Cleveland, Ohio. First of all, the city gets a bad rap. It is definitely not "the mistake on the lake" as folks used to call it. In fact, Cleveland has some of the most gorgeous neighborhoods I've ever seen and autumns that absolutely take your breath away. Oh--and hands down Cleveland STILL has the most perfect summer climate of any place I have ever lived.  Seriously. (And I'm from Los Angeles, remember?)

But.

Cleveland, Ohio is filled with one thing in great, great abundance. And that is people from Cleveland. And if they aren't from Cleveland, they are from some other part of Ohio or married to someone from Cleveland. So what does this mean? Well for me, the twenty five year-old woman who was living there at the time, this meant that everyone socialized around their families and old friends. Everyone. And though that is one of the very sweet things about Cleveland, Ohio, at times, that was one of the hardest things about living there and not being from there.

"The Jake" -- which I think is now called something else.

Case in point:

Me on my day off: "What are y'all doing tonight?"

Friday night? "Bidwist and Spades at Auntie Carol's house! Wanna come?"
Saturday night? "My cousin Marco is having a cookout! Or my high school buddies are all meeting up somewhere! Wanna come?"
Sunday night? "Oh yes! (insert - mom, grandmama, mama and grandmama, sister, uncle, cousin, great auntie, et.) is making Sunday dinner. Wanna come?"

Arrrgghh! This is no exaggeration.

And that was hard for me because I was one of the rare transplants there. And that was rough.

The Rock and Roll Hall of Fame, Cleveland, Ohio

So this phone number belonged to this dude who not only LIVED in Cleveland, but who allegedly was one of the very, very few who was not FROM Cleveland. In fact, the dude was from Brooklyn, New York which I decided sounded cool enough for me to save the number.

And even call.

It turns out that this dude was indeed the "dude to know." The day I rang him up, he was coincidentally having a house party that very night.

"Come through, yo," he said in this voice that was definitely a cross between genuine interest and whatever-ness. But it had that touch of New York on it that intrigued me. I then did something totally out of my character--I got dressed and went to a party across town given by a total stranger and full of other total strangers. Just great.

And so. I go to this party which is packed full of people. The girls are all cliquish because clearly they all know each other from high school or from Ohio State. (Or Miami University of Ohio.) Um, yeah. The dudes are carefully eyeing me over and wondering who I'm there with. Eventually I meet Brooklyn-to-Cleveland Party Dude and he greets me with that same hybrid of genuine interest-slash-whatever-ness. "Hey! What's up, yo?"

So after that, I was alone again and sitting on a chair tapping my foot to the booming rap music. I figured that bopping my head would look lame although what I was doing probably was pretty darn lame already. Anywho, I'm minding my own business alone on a folding chair when one of my favorite old school rap songs comes on. Yes! Eric B. and Rakim's Paid in Full -- which is my JAM. There was no one around to high five, so I tap my foot even more and give up on not bopping my head. And since that song is my JAM, without thinking, I begin reciting the lyrics under my breath with rapper hand gestures:

Thinkin' of a master plan
'Cause ain't nuthin but sweat inside my hand
So I dig into my pocket, all my money is spent
So I dig deeper but still comin up with lint
So I start my mission- leave my residence
Thinkin how could I get some dead presidents

That's when this guy attending the party says to me, "Damn, you know all the words to that song?"

I looked over at him and smiled while still nodding my head. You know--in that way you do when your JAM is on and you still want to hear it all? That way that says, "Uh huh, now be quiet 'cause this is my JAM." So with a smile in his direction I close my eyes and keep spitting the rhyme:

But now I learned to earn 'cause I'm righteous
I feel great!  so maybe I might just
Search for a 9 to 5, if I strive
Then maybe I'll stay alive
So I walk up the street whistlin this
Feelin out of place 'cause, man, do I miss. . .

And next thing I knew, this guy was sitting on the chair beside me chanting the rest of the song in unison with me (complete with hand gestures):

A pen and a paper, a stereo, a tape of
Me and Eric B, and a nice big plate of
Fish, which is my favorite dish
But without no money it's still a wish
'Cause I don't like to dream about gettin paid
So I dig into the books of the rhymes that I made
To now test to see if I got pull
Hit the studio, 'cause I'm paid in full. . .


Then we both started laughing. That's when I realized that he was kind of cute. Even more than that--he was very cute. We chatted some more and I learned that he, too, was one of the few Cleveland transplants who'd come to this party just to get out of the house. After lamenting a bit about what it feels like to be in Cleveland but not from Cleveland, we agreed to exchange numbers and meet up some day.

Simple enough, right?

Well that "meet up" became a date. And subsequently became a relationship. In fact, it was one that got quite serious, actually. So serious that I forgot all of my criticisms of Cleveland, Ohio and found myself complimenting things like the Rock and Roll Hall of Fame and Jacobs Field because they'd proved to be choice locations for budding romantic outings.

We officially became a couple. A transplant couple hanging out all around Lake Erie. One year later, work transferred him to another city pretty far away. But we continued a long distance commitment. I'd see him on all of my vacations and he'd visit often. He was nice to me and for the most part, there was nothing much wrong with the relationship other than the fact that we were broke and in separate cities.

Two plus years into our relationship, he decided to apply to graduate school. I'd been asked to be chief resident at this point so that meant once he started school, we'd both have two more years before finishing up. I naturally assumed that grad school would be somewhere at least driving distance to Cleveland. Or better yet, at Case Western.

Anyways. Around that time, I had gone to Columbus to visit my friend and med school classmate Jada. Jada and her husband Felix had moved to Columbus for Jada's residency and having them so close was a godsend. On this particular weekend, I was chatting with them about my relationship and my honey's upcoming grad school plans.

"That's great that y'all will be closer together!" Felix said. "Ohio State, Case and even Michigan are all close. Is that where he's looking?"

I actually wasn't sure. So I said that. "I'm not sure. I'm assuming so."

And Felix said, "Once Jada and I got very serious, I knew I wanted to be wherever she was. Sometimes it's not in your control to be together. But when you have it as an option, what you do with that option says a lot."

He kind of just left it at that. I let that marinate and remarinate. I thawed it out and marinated it again. Something told me to pay attention to those words, so I stuck it on a post it note in my head for later.

With Jada on my wedding day

A few months later, I was visiting my man-friend during a vacation. We had just toasted to our two and a half year anniversary and to me getting asked to be chief resident. And that's when he dropped the bomb on me.

"Good news. I've been accepted at UC Berkley and at Emory."

And that needle scratched the record loud as hell at that moment. UC WHO? Emo-WHAT?

Unless there was a University of Cleveland at Berkley, neither of those options sounded close. And the operative word there was "option."

"Did you get accepted to Ohio State? Or Michigan?" I implored.

He looked down and sighed. "I didn't apply there. I just really wanted to go somewhere outside of the midwest."

My head was swirling and my feelings were definitely hurt. He had an option. He did. What did this say about me? About us? Nothing? Everything? I wasn't sure.

"Did you apply anywhere near where I am?"

Without making eye contact he shook his head no. "I accepted the position at Emory."

And that was that. No discussion beforehand or anything of the sort. I lived in Cleveland, he lived in far-away-from-Cleveland and had been given an option to go somewhere-anywhere and had chosen to move to even-further-from-Cleveland.

"This doesn't mean we can't make it work," he mumbled. "I just. . . I just wanted to go to a better city."

A better city? That stung even more.

Now. Let me be clear on something: This guy was not a bad boyfriend. He was thoughtful and romantic and reliable and kind. As far as relationships go, this wasn't a bad one by any stretch and I would be hard-pressed to find some awful quality he had that made him such a horrible person to be with.

But still. He had an option. This time, even if it meant a bit of sacrifice, he had an option. And his option was not selected with me as a major factor.

A surprising amount of peace and clarity came over me after that announcement. I remembered Felix saying "I just wanted to be wherever she was." And yes, I recognized that Felix was Felix and this-guy was this-guy but still. That made me wonder about our two years and where I stood on the priority totem pole with him.

When he dropped me off at the airport at the end of that trip, I looked over at him with tears in my eyes. "You know what? I'm not her."

And he said, "Huh?"

"I'm not 'the one.' If I was, you would have found this decision harder to make. It would have involved me more and the thought of being apart for two more years would have been more of a struggle. If I were 'her' -- or 'the one' -- I may have even been able to compete with cooler cities. But I couldn't since I'm not her. And you know what? That tells me that you aren't 'him'."

He looked crestfallen. "Are you breaking up with me?"

"You broke up with me already," I replied quietly. "And it's okay. I'll be okay."

"But I don't want to break up," he said. "I don't."

"I don't want to be in a situation where I'm an afterthought. I don't. The man for me would have at least applied to Michigan or Ohio State. And the woman for you would have made you want to do that."

I have no idea where this zen came from. But it came from somewhere strong that I didn't even know was inside of me. And I'm so glad it was.

Yes, I am.

Today I am a forty-one year-old married woman and I know how wonderful it feels to be a forethought and not an afterthought. And it was worth the wait.

When Harry and I were about to get married, we had this lovely rehearsal dinner where people stood up and gave these heartfelt toasts. One of the toasts was from my maternal grandmother who had known over fifty years of marriage to one true love. She shared a few words about her experiences and after the dinner was over, she pulled us aside for more words of wisdom.

There's wisdom behind that smile.

"Remember," she spoke firmly,"marriage is an unselfish walk. Every marriage that fails--every single one--they fail for one main reason: selfishness. Not spending time with your spouse? Selfish! Spending all the money? Selfish! Not helping around the house? Selfish! Only doing what you want to do? Selfish! Not helping with the kids? Selfish! Not making love because you don't want to? Selfish!"

And, of course. We both knew there were caveats like addiction strongholds, mental illness, and tragedies. But she was talking about her experiences with most marriages. And she had earned some authority on the subject. Us? We were riveted. She was preaching, do you hear me? Preaching! And she didn't stop there.

Grandmama never has been shy.

"And not forgiving each other? That's selfish, too. If you aren't ready to think about someone else as much if not more than you think of yourself, then you aren't ready for marriage. And you definitely ain't ready for marriage with children. But if every day, you get up and you think about how you can make each other's life easier and better today? You will always be together. So talk to each other. Listen to each other. Put each other first and make sure the other person always feels that way."

I remembered all of those words and always will. I think of that advice nearly every single day.

We keep this photo on our wall to serve as a reminder of what Grandmama said.

Today I was reflecting on my marriage to Harry and how --- dare I say it? -- easy it has been. I am thinking about how good it feels to be first on his agenda. And my grandmama was right. That takes an unselfish heart. But now I know it also takes a level of maturity and readiness that some don't ever have. I also know that the right person can ready even the wrongest person. If and only if they are the right person.

Sometimes? Sometimes you just have know when you're not "her." Or not "him." Because sometimes, you're not.

Just because a person is nice and cool and attractive and unmarried and in a relationship with you doesn't mean that they are "the one." And just because they know all the words to one of your favorite old school rap songs and just because they make you a mix tape with that song and twelve others on it, does not a future spouse make. Nope. It could mean that they're bored. Or scared. Or just waiting for someone other than you.

Gasp!

I said it. Other than you.

It's been said many times over, but I'll say it here, too. Perhaps--just perhaps--whoever it is just isn't that into you. And the kind of "into you" you need for drama-free love takes a helluva lot more than nice biceps, straight teeth and a shiny car. Or maybe they just aren't ready to be unselfish for you. Just maybe something about you doesn't make them deeply yearn to put aside their immediate desires for yours. And you know? It is what it is. After two years? It's either it's a green light or a red one--whether you want to believe otherwise or not.

I'm just saying that it just shouldn't be that hard. And when it's the right person? Living in a crappy city is a sacrifice you will at least consider.

But again--you have to be ready. And you can't make anybody get ready. No matter who they are and how much you try or how many kids you have or how much history you have together. It isn't exactly an age thing either because there are some very ready young people and some really NOT ready older folks. Again, it's either a green light or a red one--and even if you choose to keep running those big red lights, that doesn't make them turn green.

Oh yeah--before I forget.

I'm sure you thought--Emory? That-guy went to Emory? What ever happened to that-guy? Did you see him? Do you see him? Uuuhhhh, no. My guess is that at some point he met the right person and was ready. He was a nice guy, so I'd imagine this is the case. And no, I don't know for sure because while I do love black history, I don't generally unearth it when it comes to my romantic past. No, I do not. (That could be a whole 'nother post, now couldn't it?)

I am thankful, however, for what I learned from that experience. The strength it took to love myself that day is probably what ultimately positioned me to receive someone as wonderful and ready as the BHE once I came to Atlanta. (Who, after all of that, just so happened to be from Cleveland, Ohio.)

Ironic huh? I'd say.

You know? One thing my grandmother didn't say that I will say someday to my kids or grandkids should I be so lucky to give them advice on the eve of their nuptials:

"The only way you can be ready to put your spouse first is to have first had practice doing the same for yourself." 

Other than that, I'll say everything else she said.

Wisdom sealed with a kiss.

I know. I haven't been married 50-something years. And no. I don't know exactly what the future will hold. But I do know this:  When people show you who they are -- and where they are -- especially in relationships, you should believe them.

***
Happy Sunday.


Now playing on my mental iPod. . . . this. . . . .(I apologize in advance for this being stuck in your head all day.)


. . . .and this. . . . .


. . .and especially THIS. . .because I am so thankful for the BHE coming into my life! I can rock out to this for hours--it's one of my BHE anthems!