Getting to know you.

Bryan O.: half med student - half musician

Getting to know you,
Getting to feel free and easy
When I am with you,
Getting to know what to say

Haven't you noticed
Suddenly I'm bright and breezy?
Because of all the beautiful and new
Things I'm learning about you
Day by day

~ from The King and I

__________________________

Last month I had a student on my team that I'd never met before. I'd seen him in passing, yes. But no, I hadn't ever really met him. Anyways, this is actually one of my favorite situations to be in--working with people where I have no idea what to expect. Because you know what? I simply expect the best and treat the person accordingly.

That makes me think of a part of a book called "The Art of Possibility" by Rosalind and Benjamin Zander. The part I like in particular is this chapter called "Giving an A." It's all about how treating people up front like they are an 'A' -- or exceptional -- allows them to live up to it. It's about not waiting for people to fail or forcing them to live up to something. . . . but simply assuming that they will wow you and excel long before they do.

And you know what? In my experience, when you treat anyone this way they almost always do.

Anyways.

That wasn't my point so I won't stay on that. But let me just tell you about our June ward month. It was busy. Busy as I-don't-know-what. The patients were sick and perplexing. I was tired and our team was, too. The month required a lot of focus and reading and discussing. It was tough.

But. 

Every day when we'd get ready to round, I'd start with some small talk. Like, "What is your favorite dessert?" or "What's your favorite restaurant in Atlanta?" I'd also ask things like, "What did you do on your off day? Did you do something fun?" Then I'd listen as they answered and then share something about my thoughts on those same questions.

I do this with all of my ward teams. Invariably it allows me to get to know my team better. And that's super important for team-building and for establishing a good learning climate. It's also critical to not forget -- no matter how busy things get.

And this month? It was a busy one.

But still.

I found out that Bryan -- the student who I'd never known before the month -- is a newly wed and he describes his wedding day as "totally awesome." He's in his fourth year of med school but technically it's a fifth year since he just finished getting a Masters of Public Health. And, as of right now, he thinks he might want to pursue a career in Internal Medicine. 

Also.

He installed a chandelier in his house all by himself on an off day in June. And he plays a mean guitar and writes his own songs (most of which are for his wife.) Yep. 

Oh--and he got his first guitar when he was twelve.

So while we waited for elevators or walked to conferences and patient rooms, I learned all these things about him. Which made all the rest of the things we talked about -- like people being sick-sick or nearing the end of life -- easier.  It made explaining things like severe sepsis or HIV-related diarrhea or acute decompensated heart failure less daunting. It also opened the space up for questions to be asked and thoughts to be shared. Not just my questions and my thoughts--but everyone on the team. On every level of the totem pole. 

See, all that small talk creates a safe space and an easy space. Which is very, very necessary if you ask me.

That reminds me.

When I was a student on Medicine, my attending introduced himself to me three different times in one month. Asking me if I was the medical student on the team--because he had not made getting know me (or even remember me) a priority. At all. Do you know how unimportant that made me feel? How ignored and undervalued? So me, I go the whole other extreme. I want to know as much as I can about the people I'm working with. About my learners, yes.

But especially about our patients. 

I took pride in the random things I learned about the people we cared for last month. Some things were amazing--like how one of our patients had a dream to dance with the Alvin Ailey American Dance Theater or The Dance Theater of Harlem. And how he STILL does a meeeeean "six o'clock." 

Then he explained to me what a "six o'clock" was since I didn't know. He sure did.

Alvin Ailey Dancers: The one in the yellow is doing a "six o'clock" 
-- the other brother appears to be at about 5:50.

Other things I learned were awful--like my patient and his wife who told me that a few years ago their adult child got in a dumb argument with someone and then that someone shot him point blank in the head while he was eating a pecan waffle in The Waffle House. Then unloaded the rest of the gun into his chest ending his precious life. All over a stupid spat over some woman that he didn't even know.

The day I learned that I was rounding and they looked sad. I asked and they told me. It was the anniversary of that son's death so it was a hard day for them. They needed to talk about it and I was glad they did. So it turns out that the person who killed their son went to jail. And do you know what my patient said to me? 

"It never made me feel better, though. I watched that boy's mama's face when that verdict came down and knew in my heart that two people lost they baby that day." 

And his wife chimed in, "Wasn't even twenty-one years old and they put him away for good. They was both too young to be gone."

And I listened to that story and then I listened to his heart and his lungs, too. I've learned that doing the former always, always helps me with the latter. 

Always.

So the answer is yes. Yes, I did notice that suddenly you're bright and breezy. Because being intentional about getting to know you makes taking care of you or teaching you or treating patients with you more fun.

It also helps me with "giving an 'A'." 

Does that make sense? I hope it does.

Yeah.

That June month was a tough one. Tough and trying. But we took excellent care of our patients--that we did. We also got to know each other better. 

And that was a bonus.

I hosted our end-of-the-month team dinner at my home last week and asked Bryan to bring his guitar. You bet I did. And don't you know he gladly obliged me, sitting cross-legged on my sunroom floor strumming a song and singing words he'd penned himself? He sure did.

And that? That was a bonus, too.

***

Happy Monday-about-to-be-Tuesday.

This version is playing on my mental iPod. Might see if I can get Bryan to play this next time.

Camp Papa Postcard Classics: Fit to be tied.

Dear Mom,

Remember all the clothes you packed for us to bring to California? Well, we didn't need it because Papa got us some cool muscle shirts with shorts that match. We picked them ourself. 

Mom? Papa kind of likes to dress us like twins. But nobody will think we are that because I am a whole head taller than Zachary. Or at least a whole forehead. 

I like the cool clothes, though. Next time I will help you pick some cool clothes for us, okay?

Papa said why don't kids know how to tie shoes good and tight anymore? He said that's a damn shame.

Mom? What does "damn shame" mean? Papa said to ask you.

Love,

Isaiah, Age 7

Just sort of.

Leaving the Grady parking garage on Saturday.

I'm sort of stressed today. Not all the way stressed. Just sort of.

Do you ever feel that way?

That's how I'm feeling right now. For no real good reason, either. I'm off of my busy ward month. I'm even off of work for most of this week. But still. . . .I have this little tiny undercurrent of stress today.

And I don't like it.

Probably the angst of going from being pulled a million directions with wards and orientation to being given time to do nothing at all. Not even child care related things.

And while, yes, I do miss my children, this is their fifth year at Camp Papa, so it isn't that. It's the rapid downshift I just had. I know it well. See, I always feel this way when I first get off of a busy inpatient service. I have this gnawing feeling like I've abandoned my patients -- even though I know that I've turned them over to an absolutely able colleague. It's silly but I just do and it's hard to shake. In fact, it takes every bone in my body not to go up to Grady just to . . . . check on them. People always say "zero to sixty" but leaving the wards is like going from "one hundred to zero." It's weird. So it plants this tiny seed of uneasiness in me. Which I don't like.

It took a moment for it to really kick in because my weekend was busy. I did fun things which allowed me to ignore it but today I had time. Time for it to marinate and seep in. That feeling of being sort of stressed.

Just sort of.

And I know what it means. It means I need to exercise with some good music playing in my ear. And it especially means I need to write.

Oh and my kids are out of town so the other thing this sort of stressed feeling sometimes means is not really an issue, thank you very much. (We're all adults here, aren't we?)

Ah hem.

And so. I'm off to do those things.

First -- exercise. The kind that makes you sit hunched over with your elbow dripping and propped on equally sweaty knees. The kind that makes you feel strong and good and healthy. And I already have a kick ass playlist for my iPod.

So first, that. No, not in the hot sun. In the gym.

Duh.

Next --  I will write. So stay tuned for that part because you will see the fruits of it here.

Oh yeah, and if I can find some good gazpacho to eat somewhere, I will do that, too. Sister Moon? Do you have a gazpacho recipe for me? If so, make sure it's easy. Gazpacho always makes me happy and will certainly be a part of the panacea for my "just sort of" stress.

Do you have a panacea for your "just sort of" days?  Do tell.

(Make sure it's legal. Heh.)

***
Happy Mundane Monday.

Camp Papa Postcard Classics: The proof is in the Skyping.

Dear Mama,

I TOLD you I could read for real by myself. Big kid books, not just the little books with little words like "if" and "it." I can read big words, too. Like "Constantinople" and "Timbuktu." 

(That last part is from Dr. Seuss. He's pretty good.)


Love,

Zachary, Age 5 (and a half.)

P.S. I want to download some stuff to read on the iPad.

What I think.

 "I am a Grady doctor. What do you think I think?"

That's what I said today to the man in the Subway lunch line who asked me what I thought about the Supreme Court upholding the Obama's signature health care law.

You know. The one that will grant millions of Americans better access to health care and improve overall public health? Yeah. That one.

He said it kind of smug-ish and confrontational-ish. Which annoyed the crap out of me.

Then when I gave him my response he returned it with a snort and a half upturned smirk.

Yeah, he did.

I started to bite and entertain that smirk. I started to go in on him and ask him how much his Brooks Brothers suit cost him and also how many times as a child he'd seen somebody cook up some crack cocaine in the same kitchen his mama cooked dinner in. I wanted to ask him how many grocery stores were in his neighborhood and, if there was one, what was the ratio between it and the liquor stores. I wanted to talk to him about how much money--no wealth--his family or even his friends' families had that went waaaay back to, like, I don't know. . .  a time when people worked for free to help with attaining said wealth.

But I didn't.

Instead, I just turned away from him and said, "Hey Marcus! You doin' alright today? I'll have the turkey on wheat--six-inch!"

Because that snort and that smirk were enough for me. Yeah, it was.

Look. I am not trying to get all political on this blog. Not today I'm not. Like him and some others, I make decent money and like keeping my money in my pocket just as much as the next person. And. I'm fortunate enough to have a job with benefits that affords my family health care.

Yet.

I realize that my position in life is only a little bit hard work and a lot of bit being blessed to be born when and where I was to the parents I have. I think poverty and poor health choices are complicated as hell. Way more complicated than just telling somebody not to get the crispy fried chicken sandwich over the grilled one. Or admonishing them to get water instead of sweet tea.

Look. I'm a Grady doctor. And I know that it isn't as simple as some want to make it. I also know that a whole lot about a whole lot in this country is messed up and unfair.

Messed up. And unfair.

 

And can I just say that I find this image above both disturbing and disappointing on more levels than I can even begin to impart here? Good, because I do.

So what do I think about all of this, Mr. Upturned-Smirk-on-Your-Face-in-Subway?

I think you and the people holding these signs need to come down to Grady Hospital so that you can meet a few people who tried to make good life choices and got sick anyway.

I also think that next time you order that ham sandwich combo in Subway, you should get the baked Lays instead of the regular ones, the six-inch instead of the twelve-inch, the wheat bread instead of white, and that you should go easy on all that mayonnaise and oil.

You should also hope you never lose that job that your badge indicated you are lucky to have--but if you do--and you keep on ordering like you ordered today in the Subway lunch line--things just might work out in your favor, too.



That's what I think.

***

Four thumbs up.

 

The one in the short white coat is Katie N. She had just finished presenting her first patient ever on the Internal Medicine service. 

And she did a fantastic job. 

The two interns flanking her are just two days away from being big time upper-level supervisory residents. Can't you tell? I just love how non-interny they look in this picture.

Some people call that "swagger."

I also love how proud of herself she looks. Because she should have been.

This was my favorite moment on rounds today. Hands down.

(And thumbs up.)

***

For Shanta Z.

On rounds today: Maureen M., M2, hears her first real, true, certain S3 gallop

Back to the Bedside


Don't say you hear it
if you don't
Don't say you see it
if you can't
Don't say you're with me
if you're not

Don't

Just say
I'm not sure
or even
No, I don't
hear it
see it
get it

Then

We'll go back to the bedside
and listen again
and look again
and ask again
and get it better
and get it right
together

Why?
Because someone is counting on you
somebody's mother
somebody's father
somebody's child
all of them are counting on you
to hear it
to see it
to get it
for sure

Or at least
almost sure

This means
they're also counting on me
to make sure you do

You hear me?
You see me?
You with me?

If not
I'll explain it again
and show you again
and again
and just maybe
again

Not for me
or even for you
but more for them
the ones who are counting on us

So, please--don't

Don't say you're a burden
to teach
because
you're not

Not to me

My only real burden
is when I can't

or worse

when you don't want me to


~ K.M. 6/27/2012

***

Happy Wednesday.

P.S. Maureen really did hear those heart sounds. . . AND she came on her own time during summer break to round with me--because she wanted to.

This woman.

Some heroes don't wear capes.

This woman is one of the smartest people I know.

This woman is one of the hardest working people I know.

This woman is one of the most humble people I know.

This woman is one of the strongest and most bad-ass people I know.

She sure is.

And if I didn't think she'd punch me in my arm--HARD--I, like, would tell you that she won not two but THREE major awards this year at our institution. I'd gush all about how she was publicly recognized for it today and how I got eerily close to the pre-ugly cry since I was so proud of her. I mean, if I didn't think she'd turn beet red, I would TOTALLY, like, say that one of those awards was, like, the super-teacher-of-your-whole-hospital award and that the other was like the super-educator-of-the-whole-department-of-medicine award. 

Oh? And if I really, really felt like being obnoxious, I'd even blab all about how the OTHER one was, like, the big, bad super-awesome-service award of, like, our whole department. 

Which is a really, really big department. For real.

I mean, I would. But I won't because she's so humble that it would mortify her. And get me a scathing text message or two about how I have a REALLY BIG MOUTH.

So I won't do any of that. I mean, noooooo, not me. 

Instead I'll just tell her what I hope she tells herself when she looks in the mirror when she wakes up tomorrow morning:

"You are awesome. You are smart. You are a rock star. You are a hero. You are deserving. You are enough."

or if all of that is too much, at least this:

"Yay."

Congratulations, Wendy. It's great to see good things happen to good people.

Yay.

***

Happy Wednesday.

Lifelong Learner.

5 PM. After rounds today. Looking up the answers to the many, many clinical questions I had. 

And still have.

That I don't or didn't know the answer to.

Don't believe what they tell you. No one ever knows everything.  

Ever.

Medical school lasts forever. Believe that.

***

Stuck in reverse.

When you try your best but you don't succeed
When you get what you want but not what you need
When you feel so tired but you can't sleep
Stuck in reverse

~ Coldplay

__________________________________

"Miss Manning! Miss Manning!"

I looked over my shoulder and saw you coming toward me and waving your hand. I waved back. I figured you were just saying hello so I kept walking toward the hospital.

"Miss Manning! Miss Manning! Wait! Wait! Wait!"

Your feet were shuffling quickly behind me. There was urgency in your voice. Once you reached me you repeated my name, more to catch your breath than get my attention because I'd already stopped to wait.

"Miss Manning," you panted and you reached out to shake my hand.

"Hey there, sir."  I squeezed it tight and covered it with my other hand. "What's up?"

Your eyes were dancing and your face had a film of sweat over it.  Your clothes were unkempt and pasted to you with sweat. There was a nervousness in your disposition that made me worry about you immediately.

"Miss Manning, I'm hungry. I'm hungry. I need some money to get some food."

I was going upstairs to round. But that wasn't the issue.

Something was up with you. Something wasn't right. Your voice was staccato. Your hands were waving and shaking so I could see the burns on your thumbs.  The erratic behavior, the jumpiness, and even the pressure in your walk suggested that something else was up with you.

And you weren't a stranger to me, so this wasn't the same as being presented with this request by someone I didn't know.  I decided to keep it simple in the interest of time.

"I don't have money. Let me speak to a social worker. Let me--"

"Miss Manning! Miss Manning! I'll wait for you to go get some money, okay? Okay? I don't have my medicine either. I need it. I'm sick. I don't feel good. Please."  Your feet kept shuffling. Your eyes bouncing wildly and that film of sweat now coalescing into beads on your brow.

"I won't give you money. You know I won't."

"Miss Manning! No, it's not. . . I mean. . . Listen I promise . . .I promise that I--"

"I don't know what's going on with you. This is making me feel nervous." I registered the security officer standing several feet away from me even though I felt pretty sure that you'd never harm me. But something was up with you that might turn you into a puppet on a string with actions you don't see or want or mean. "Sir? Are you using again?"

"The thing, Miss Manning, is that it's hard. You know it's hard."

"Sir. It makes me sad that you're telling me you want money for food and medicine if that's not what you really are looking for. What happened when you left us?"

I was referring to you leaving the hospital earlier in the month. You shrugged.

So we just stood there staring at each other. I was already late for rounds. It was like standing in front of a giant mountain that needed to be torn down brick by brick. All I was doing was yanking on one, somehow hoping this would cascade the whole thing down.

But deep down I knew. I knew I couldn't fix this in five minutes before rounds. Just like I couldn't fix you in those five days. And we both realize that the only one who can fix you is you.

That made me feel sad. And helpless.

I think you saw that in my eyes.

"It's hard, Miss Manning. Hard to break free." You wiped your face with your hand and shook your head. Then your feet started walking backwards away from me. Like a puppet on a string. "Be blessed, okay? I got to go. I know you care about me, Miss Manning. I do. I'm gon' keep trying to break free. I'm gon' keep trying, okay?'

Keep trying. To break free.

The last thing I saw was you diagonally crossing the street, disjointed like the marionette that you still are.

Still erratic. Still anxious. Still stuck in reverse and not quite ready or able to break free.



***
Welcome to Tuesday.


Now playing on my mental iPod. . . . . haunting words, haunting lyrics. . . please listen.