A lovely day.

When I wake up in the morning, love

And the sun light hurts my eyes

And something without warning, love

Bears heavy on my mind.

Then I look at you 

and the world's alright with me

Just one look at you 

and I know it's gonna be . . .

A lovely day

~ from Bill Withers' "Lovely Day"

I don't really consider myself a birthday-ey person. Wait--don't get me wrong. It's not like I'm a wet blanket when it comes that day. I welcome some celebration and love receiving calls, texts, messages and (duh!) gifts. But what I mean is that I don't generally drumroll up to it for the month before it. And I'm definitely not the kind of person that expects everyone around me to put it on their calendars as a national holiday.

I'm the same person who only has (real) birthday parties for my kids on years divisible by five and who (sort of) wishes the whole world would get on a similar schedule with their kids, too. I've also been known to think of someone all day on their special day but then smack my forehead almost to the point of concussion on the following day for neglecting to send a message or a call before the clock struck midnight.

Uhhh yeah.

One of my close friends called me yesterday, which was the day after my own birthday. We launched into a gabfest and, like usual, we asked each other for recaps of our Friday night since we'd played a bit of phone tag on the days leading up to it. We'd also missed each other in the hair salon which is often one of our main excuses for good girlfriend time. Anyways. Somewhere along the way I mentioned some of the swanky things that made up my Friday evening (courtesy of the BHE.)

"Dang, girl! A night in a hotel? It's like THAT? That's how Team Manning rolls on a random Friday? Daaaaang!" she teased.

"Well, my mom had the kids for the night. Well, actually the whole weekend."

"Damn! Ask your mama if she's looking for any more kids to be dropped off."

We both laughed. Then I sat there debating about whether or not to let her know what was obvious that she'd forgotten. It was like THAT because yesterday wasn't exactly a random Friday. It was my birthday.

Now.

This friend is a good, good friend. She is one of my go-to sisters for affairs of the heart and one that I trust completely. For the other three hundred and sixty four days of the year that aren't my birthday, she is wonderful. And now that I think of it, even on my birthday she's a cherished friend, too.

I was reluctant to say something because I knew she'd feel bad and launch into a looping apology. But if I didn't mention it, one of our mutual friends would and then she'd call me three days later with an even more vehement version of the first one that I was trying to avoid.

"What'd you do last night?" I asked changing the subject.

"Not much. My son had a late baseball game so I was caught up in all of that. Story of my life."

"It's so hard to believe he's in high school. I thought he was driving now?"

"He is, girl. But you know they like to still see mama at the game!"

We both laughed again. But then my luck ran out.

"So what was up with the hotel action? That Harry is the man."

"Oh. It was my birthday yesterday."

Silence.  Then, three-two-one. . .

"Your BIRTHDAY was YESTERDAY?! Oh my GOSH! KIM!!! I SUCK as a friend!!! I'M SOOOOOO SORRY!!!! AAAGGGHHHHH! I can't believe I did that!"

"It's okay, sister. I'm serious. I really, really am."

"No,  it's not. I suck. I'm sorry. I'm so, so sorry, man. Damn."

"It's fine. Really."

But it was too late. She was reacting to me in the way you react to birthday-ey people whose birthdays you've forgotten. Doo loops of sorrys and grand plans to make it up to them. And I guess for birthday-ey types that's very important.

But I'm not so birthday-ey.

So I told her. "Look. Here's the deal. You have been a wonderful friend to me for every single year of the last twenty-two years. This year we've remained closer than ever and I know that if I need you I can always call you no matter what. I care far more about the kind of friend you are to me on the other three hundred and sixty-four days of the year than just you remembering my birthday."

And she still felt bad but said, "Thanks for saying that. But I'm sorry. I really am." Her voice was soft and quiet. She did feel bad.

"Harry always says to me that you have to pair up with the right person. Like, in your marriage you have to be with the person who meshes with you and who is easygoing about the things that are your quirks. They also have to be the kind of person that steps up for the things that really, really are a big deal for you. The same goes for friendships." She stayed quiet so I continued. "So you happened to pick someone as one of your best friends who doesn't hate you or haze you for not remembering the exact date of her birthday. Because she isn't so birthday-ey."

"Birthday-ey?"

"Yeah. Birthday-ey."

"That's crazy, Kim. Who doesn't like their birthday? I know for a fact that you love having birthdays."

"I do. That's true. But I guess I don't see it the way others do. And no. I would not be okay with Harry forgetting my birthday but not because of my birthday. . .just more because if he forgot it--as my husband-- it would probably be a symptom of something more."

"Like being an asshole?"

"Perhaps."

We laughed some more.

So, no. I am not birthday-ey but I do like and appreciate having birthdays. I am also not married to an asshole, thank goodness.

And so. I had a wonderful day. I was delighted by every single acknowledgment and affirmation that I received that day. My heart was also warmed by the ones I received after.

It was a day that involved many of my favorite things. It started with hugs from my sweet boys. A kiss from my husband, soft and tender right in front of our boys who squealed and said eeeeeeew! I got to teach one of my small groups and was flooded with their well-wishes.

Jennifer D. from Small Group Gamma made me a cake that, I am now certain, was the most delicious one that I have ever had in my forty two years. And Leah from SG Gamma gave me a luscious bouquet of flowers.

"I love flowers!" I told her.

"I know!" she said.

Erica U. gave me three super packs of chewing gum (since I always take hers) and gave me a ride home from the med school which I appreciated just as much.

My Grady BFF Lesley and I threw on some exercise clothes and went for a nice power walk together. Then we had brunch at this adorably cute neighborhood bistro. We laughed and talked. We did our favorite things that we always do on the other three hundred and sixty four days. We also ate good food. And then walked it back off.

I met with Bryan O. about his residency applications and spoke on the phone with Sandeep K. about his fellowship interviews. And that part was good, too.

All day I received emails and text messages and phone calls from all over. I smiled at the many, many lovely comments from our blog community because that, too, was splendid because it let me know how fortunate I am to have this in my life.

After school I picked up the kids and took them to my (awesome!) mother's home and she greeted us all with a big hug and a big smile. She didn't want me to take her picture but I tried. After leaving them, I drove straight to downtown Atlanta where my dear, sweet BHE was waiting for me in a swanky boutique hotel suite.

Which was awesome. Partly because the room was lovely and festive and opened up to a perfect view. But more because it reminded me that the same guy who had done all of this was just as consistently good to me on the other three hundred sixty four days.

So dinner was involved. Reconnecting and reflecting was involved. Gifts were involved. But mostly love was involved. Rich, deep, authentic love.

And I woke up with a big smile on my face because yes, it was a wonderful birthday, but really it's a blessed life. Not perfect. But perfectly blessed.

So no. I am not birthday-ey. I will more than likely never fall out with anyone over missing my birthday. But miss or forget me repeatedly on those other three hundred sixty four days? I'd be far more concerned about that. Would it lead to us falling out? Hmmm. Probably not a true "fall out." But it would lead to some redefinition of the relationship on my end.

The point of all of this? Hmm. I'm not sure there really is one. But I guess I'm just saying that consistency is important to me. Reciprocity matters. Sharing those laughs is great and asking me to bear some of your heavy is fine with me as long as sometimes you're okay with holding on to some of mine. Because that's what authentic friendships and relationships are built upon--consistent reciprocity.

And that? That takes a lot more than just a single day to create. And, at least for me, a whole lot more to destroy.

***
Happy Sunday. I hope yours is a lovely day all year long.

Now playing on my mental iPod. . . .what I think about and care about all year long.

42.

It's my birthday, y'all! And in case you didn't know it--42 is the new 42! I have no issue with my age and don't mind you telling somebody. Yes. 4-2. Not to be confused with 3-2 or whatever other number somebody prefers. I'm glad to be the age I am. Sure am.

42? Bring it!

Touch me in the morning. (Or not.)

me and my patient holding hands, 2010

Touch me in the morning
Then just walk away
We don't have tomorrow
But we had yesterday

Wasn't it me who said that
Nothing good's gonna last forever?
And wasn't it me who said
Let's just be glad for the time together?
It must've been hard to tell me
That you've given all you had to give
I can understand you're feeling that way
Everybody's got their life to live. 

~ from Diana Ross' "Touch Me in the Morning"

___________________________________________

When I enter a patient's room or approach their bed, the first thing I do--almost always-- is reach for their hand. For me, there's just something about that first point of contact through touch that seems to get things off on the right footing.

My style of touching patients is one that fits my personality. In general, I am more affectionate than not, so nothing about touching the hand of a person has to be forced or calculated. Sitting next to a patient on their bed (with their permission, of course) or reaching for their hands again at some other point in our encounter often happens, too. Again, part of that has to do with the fact that I believe touch is important. But a substantial bit is simply wrapped into my M.O. in general.

I'm reflecting on this this morning because a fellow health care provider asked me my thoughts on it recently. This friend had experienced an awkward interaction with a patient and, though it wasn't their intention, the patient was offended. He even likened this gentle interaction to being "patted like some kind of dog." That humble provider immediately apologized and told the patient that these words would be taken to heart.

And before anyone casts any judgments, it's best to agree that we weren't there. It's also fair to say that I know for sure that patting the patient "like some kind of dog" was not the intent behind that interaction.

So that moved us to this question of touching other human beings in the clinical setting. What is cool? What isn't?

Lord knows that I'm not an expert on the topic but since I am a "toucher" I gave this all some thought. I'm very interested to hear yours, too. I know my friend who had that experience would be as well.

I believe that "touching" patients and people has far more to do with just physical contact. It involves eye contact, instincts and even subtle things like variations in the intonation of the voice. My handshakes start out formally. In those first few moments, I do my best to make an assessment of what is and isn't okay with that patient.

There are some people who immediately cover my hand with their own which prompts me to do the same. Before I know it, we're in one of those cozy four-hand handshakes that quickly becomes the equivalent of being offered a warm blanket or some hot cocoa when entering someone's home. This might be the person who pats the side of their hospital bed and welcomes me into their personal space. Or even the one that gets a big hug from me as they're being discharged.

But then there are other patients who, though equally wonderful human beings, just aren't so keen on all the touchy-feeliness. My friend Psonya (pronounced Sonya) has said more than once to me that she is no big fan of being hugged. Though that's usually said in jest, I do often think of her and that preference in the context of my patients. Because Psonya happens to be quite warm and welcoming to others -- just not all up in her personal space. (That doesn't mean that as my friend and not my patient that she won't get hugged by me anyway.)

So the point? Wait, what was my point? Oh. The point I'm making is that there are people and patients who won't be too happy with hand pats and being tucked under covers before you leave their rooms. But that doesn't mean that they're cold or aloof. It just means that this isn't how they roll.

More than anything you just have to pay attention. Watch their body language, facial expressions and reactions to the things you're doing and saying. Sometimes it seems like things are all chummy but then a ripple of discontent might roll over the patient's face that tells you too back off of the whole "overly familiar" thing. That's when you autocorrect yourself and go back to the formal default.

I'll say that again. Formality is the default. If you're socially awkward, a not-so-spot-on judge of situations, or simply not one who feels natural in touching other human beings that you don't know well, formality is the safest default of all. But don't forget your other components of touch -- eye contact, facial expressions, and voice intonation.

At least that's my opinion.

Then there's the type of touch. Hands seem to be the safest and least likely to lead to offense. I'd be lying if I told you that I hadn't touched the face of a dying or critically ill patient or that I hadn't ever patted tears off of cheeks. And yes, I've even sat right beside one of my F.P.s in her hospital bed while listening to Sam Cooke on my iPod and dissecting whether his raspy voice came from just soul, cigarettes or both. I've pulled socks back onto cold feet and even scratched more backs than I am willing to admit. But all of these broaches across those personal-space barriers were done with close attention.

Now. To my friend who asked that question:

Do I always get it right? Nope. Just two weeks ago I was caring for a patient in the hospital who was dying. Her family was there every single day for every single moment I cared for her and after lots of hoops and confusion we arranged a discharge plan that worked best for this patient and her loved ones. In this instance, that was home hospice. The interactions with the family and the patient had been so tender, so sweet. The patient was so weak that I often took her hand and held it throughout our encounters without much physical reciprocity but her eyes and facial expressions seemed to appreciate it.

So what happened? I took this to mean that the family was in a similar place. But this family had some cultural mores that I hadn't given enough thought to observing. As they left, I knew that I'd not see her again. I knew that. So I squeezed her hand and she gave me a weak smile with eyes at half mast. Then I approached the sister who'd been standing vigil for that whole week and gave her a hug. And the minute I put my arms around her, I knew that this was not the best idea.

Her body stiffened and her right shoulder slightly guarded her from allowing me to get to close. I immediately took that cue and went back to the formal default. I shook her hand and those of the other family members, too. Then I simply stood and watched them disappear down the hall in their soft and brightly hued fabrics from their African homeland. I winced at my ignorance and the lumpiness of that last moment.

So no. I don't always get it right. But I try to pay attention and learn from the things that happen.

And perhaps a pat upon the head could be perceived the wrong way by someone. I will think of that the next time I bring my hand near the head of a bedridden patriarch, keeping that lesson on a post-it note in my head for later.

Because all of these interactions are lessons. Lessons in better ways to humanize what is often cold and concrete. The science is what it is. But the human beings are each different and ever-changing. They are individuals who want their doctors and caregivers to just stick to the facts on some days, to hug them like they mean it on other days, to play rock, paper and scissors early in the morning sometimes, or maybe, depending on the day, to just get them an ice cold Sprite from the soda machine.

That part isn't science. That part is human.

So we strive to connect those dots. The human ones to the science ones to the formal ones to the familiar ones. And on some days, if we just keep paying attention, we'll get it right.

That's all I got today. Weigh in, alright?

***
Happy Thursday.

Now playing on my mental iPod. . . . Ms. Diana Ross sings it like the diva that she is!

Top Ten: Michelle, My Belle.

Dude. I'm still on the Michelle Obama high. And I ain't the only one!

I wrote a little top ten about it! Like to hear it? Here it go!

Today I bring you:

THE TOP TEN THINGS I HEARD PEOPLE SAY IN AND AROUND THE HAIR SALON TODAY IN REFERENCE TO MICHELLE OBAMA AND HER DNC SPEECH LAST NIGHT

#10  

"Did you see Michelle give her speech last night?"

"Come on, man. Don't try to play me. Are you trying to play me?"

#9  

"Michelle Obama did so well last night!"

"Man, she killed it."

"Sooo inspiring!"

"And did you see that she had on high heels, too?"

"Yeah, that's because she wasn't standing next to her husband. You know she rocks the kitten heels when he's around."

"Oh."

#8

"I was so proud of Michelle! She's her own woman! Love it!"

"Since when did we get on a first name basis with the first lady of the  United States?"

"Because she's our homegirl."

"Yeah! And she can double dutch."
 

#7

"She is so beautiful and smart."

"Awesome."

"And you can tell that she got Barack sprung."

"Uuuhh, okay."

#6

"OMG! I was crying for almost her entire speech."

"Girl, I was crying for her whole speech."

"Hell, I started crying when Mayor Castro started giving his mama a shout out! By the time Michelle came on, I was unconscious."

(laughter)

"So you didn't hear her speech?"

"I woke back up when I heard the Stevie Wonder music."

(Everyone starts singing "Signed, Sealed, Delivered.")

#5

Beauty supply dude walks in with box of hair supplies.

Dude: "Whoooo! Honey, I'm tired from watching the DNC last night!"

Lady: "Us, too!"

Dude:  "Baby, did you see Miss Michelle?"

Lady:  "Did I?"

Dude:  "Honey she DID that."

Lady: "Whatchoo talkin' 'bout?"

Dude: "Okaaaay?"

Lady: "Crushed it."

Dude:  "Killed it."

Lady: "And not the pink dress with the arms out!"

Dude: "And not the silked out hair with the flip?"

Lady: "Oh and she was like, 'Don't get it twisted, I know the issues!'"

Dude: "I know that's right!"

Lady: "She was like, 'Princeton, haters."

Dude: "Harvard Law, b---ches. What."

Lady: "What."

Dude: "She shut it DOWN!"

Lady: "Dooooown!"

Dude: "Good night!"

Lady: "Lights off."

Dude:  "Killed it."

Lady: "Crushed it."

Dude: "Whatchoo talkin' 'bout?"

Lady: "Chile please."

Dude: "Whew. I'm exhausted all over again."


 #4

"I think I might have a crush on Michelle Obama."

"I know I have one."

"Yeah, I pretty much want to be her."

#3

"Damn, did y'all see Michelle's hair last night?"

"It was beat down! Yessirrrrrr!" (note: "beat down" is a good thing.)

"Hey Sakinah! Do you think that was a relaxer or just flat ironed?"

"I would say natural but she works out a lot. It's probably relaxed and she has a good stylist."

"Y'all need your butts kicked for talking about her hair when she said so many important things last night."

"Umm, excuse me? Aren't we in the damn hair salon?"

"Oh yeah."

#2

"Aww man! I missed it!"

"And you . . .pretty much suck."

(Everyone else nodding in agreement.)

#1

Everybody:  "She DID THE DOGGONE THANG!!!"


***
Happy Wednesday. Again.

Doing the doggone thang.

"Here I am baby
Signed, Sealed, Delivered, I'm yours
(You got my future in your hands)

Here I am baby
Signed, Sealed, Delivered, I'm yours
(You got my future in your hands). . "

~ from Stevie Wonder's "Signed, Sealed, Delivered"

 

Do you have any idea how it feels to sit on your couch and see and hear an African-American woman (with whom you can fully identify) speaking to the entire world with such poise and eloquence? Of course, you do. Because, unless you were under a rock, you were watching when this one did.

Now.

Imagine seeing and hearing this in 2012 as someone who looks like her. Imagine knowing that in your own parents' lifetime that a woman just like her would have been publicly called "nigra" or "gal" straight to her beautiful face. Which means I would have, too. Publicly (not cowardly-privately as is still done to this day.)

Look.

I do have some political opinions. I do. But that's not the point of this. The point is that this shows some evolution. This. An era where Michelle Obama can take the stage baring her fit arms and shaking her beautiful hair (that you all have a better understanding of just how it got that way as readers of this blog) AND with Stevie Wonder (Stevie Wonder, y'all!) blaring in the background.

Wow.

Seeing her up there made me think of the day that I reflected on what it would have been like if I'd worked at Grady or been on the Emory faculty fifty years ago. If you read that post, you already know the answer to that: I wouldn't have been. Period. End of story. For one very simple reason that I happen to have in common with this woman pictured above.

And let's just be clear. This is not her first time on that stage. Yet  something about hearing her last night felt pivotal to me. Especially as one who looks like her. And no, she is not the first black woman to stand on a stage at the convention for a major political party. Even this year.

But.

She is the first one to take that stage this year that happens to be one with whom we can identify. And by we, I mean me. But honestly? Probably a whole lot more than me, too.

Now.

Let me just go ahead speak on this as one black woman who happens to be closely connected to many, many other black women. This woman is one that my friends and me and most sisters that I know personally can truly see pieces of ourselves in. She is our homegirl, our sorority sister, our girlfriend in the hair salon, our mentor, our double dutch buddy in the neighborhood, our style icon, our fellow mama, and our college classmate. She seems to be the one that most represents us. And while I really don't spend much time tearing down those reality housewives-slash-reality baby-mamas, I am putting my foot down and saying dammit, those black women do not represent me or any of my sista-friends.

No, they do not.

So let them entertain you. And sure, we'll admit that they entertain us (but mostly embarrass us) a little bit, too. But those women? Not a single one of them makes me stand to my feet and say, "Now that's what I'M talking about!"

No, they do not. But she did. Last night she sure did.

But I digress.

Look. I know that there's a whole world full of Michelle Obamas out there. Sisters with their terminal degrees who love their husbands and fight for their kids and try to get their exercise and who, as the sistas say, "do the doggone thang!" every single day. There is also a world full of Michelle Obamas who don't share her cocoa complexion or her educational accomplishments or even her marital status, but who identify with her "realness" just like I can.

So as for yesterday? All of us were proud. Every last Michelle Obama was on her feet and snapping her fingers. The short ones. The tall ones. The old ones. The young ones. The black ones. The white ones. And all the ones in between. 'Cause yesterday she did the doggone thang. Which pushes us to do it, too.

(Insert finger snap here.)

***
Happy Wednesday.

Now playing on my mental iPod. . . what Mrs. Obama came strutting out to the podium to. YAAAASSSSS!

Me time!

I exercised! I wrote! I read something non-medical! I took some time for me!

And it ain't over!

Next up: Shaking my hips and drinking some homemade hooch. (Okay, not really about to drink some homemade hooch but I really love how it sounds when I say it.)
 

***
Happy Tuesday. Again.

Renegades and Reality Checks.

*Names, details, all that stuff changed. You know what's up.

"If you looked in my life
And see what I've seen... 

If you looked in my life
And see what I've seen... "

~ from Mary J. Blige's "My Life"

__________________________________________

The census was light. We were down to seven patients total on the inpatient service and those seven weren't terribly active. They had problems that our team could get our hands firmly around and their clinical courses seemed to make sense. I was leaning on the nurses' station holding a cup of tepid coffee that I'd been guarding for over two hours. I knew that if I sat it down for even two seconds it would be swept out of the way in an OSHA-compliant whirlwind.

"What you daydreamin' about, Miss Kim?"

I glanced over and saw the kind gentleman who transports IV Fluids and supplies pushing his little rolling cart. Like always his smile was broad like linebacker shoulders and, like always, he approached me for the one-armed hug I'm always privy to when we meet in hallways. My eyes softened and my arm extended almost reflexively.

"Mmmm-mmmm!" We made that sound in unison. Our hugs always had sound effects, which I loved. He started it, I think, way back when I was pregnant with Isaiah. I remember him saying, "You got to hug like you mean it!" That's where the sound part came into it and, even when I don't make that sound, I often think of those words when doling out hugs because that was a good word.

"Well. I'm finished with my work already. And it's not even twelve noon." I went back to his question to let him know that I hadn't forgotten it. I twisted my face like I was trying to think of what to do next. Partly as an exaggeration but also because I really was.

"You don't even know what to do with yo'self, do you, Miss Kim?" He let out a laugh that rolled down the hall like a bowling ball. It immediately made me laugh, too.

"I reckon I don't." And I did say "reckon" because something about talking to Southerners makes me adopt my own Southern-ness, too.

"Well. I say you go and jest sit with somebody. Whoever don't have nobody to see about 'em go and spend some time. Whenever I been in the hospital that always make me feel better to get a visitor."

I held his gaze for a beat and recognized that he knew what he was talking about. Though I'd never cared for him in the hospital, it was hard not to notice what appeared to be some kind of neurologic problems. There was an irregularity of his gait; an asymmetric and irregular limp. I never knew if it was from a leg-length discrepancy, some kind of congenital palsy or even a remote stroke. Either way, it didn't surprise me that he'd had some experience with being a patient in a hospital.

I jutted out my lip and nodded in response. "That's a good idea, my friend."

"Alright then, Miss Kim. You be sweet now, hear?" And before I could answer he was on his way back to work, leaning over the wire cart and hiking up his left hip with every other step. I noticed the joy coming from him despite what he was up against and put that on a post-it note in my head for later.

"Alright then, sir." Even though he was out of earshot I felt the need to acknowledge yet another good word from him.

Instead of moving I just stood there frozen and trying to think about what to do next and who to go and "see about." I reached into my pocket and scanned my short list of patients. Two were off the floor having procedures. One did not speak very good English and was a little delirious. Another was nonverbal and rather somnolent. That left three patients. Two of them always had visitors standing vigil at the bedside. With the selection framework I'd been given in mind, I settled on the only one of remaining--the one who "don't have nobody to see about 'em."

Or at least the one who seemed that way.

I knocked on the wall near the second bed in the room and announced my entrance. She offered me an expression of pleasant surprise.

"Hi there," I said with a smile. "Just stopping back by to check on you."

They had just passed the lunch trays. I waited quietly as she lifted the green plastic cover to her lunch plate and surveyed the afternoon's offerings. Turkey, green peas, and a sweet potato. Instead of peeking under the lid of the accompanying soup, she simply peeled back the lid and gave it a sniff. She shrugged and took a sip of it. "Broth. Yuck." She shuddered and then sat it on the table, exiling it from the rest of her food.

"Mind if I sit?" I asked. I was already pulling over the bedside chair as I made that request and fortunately she didn't seem to mind.

"You ain't got no bad news, do you?" She didn't even look at me when she said that part. At this point she was sprinkling the last of the three pepper packets over everything on her plate. That sight made me smile inside because I always tease Harry for peppering everything before even tasting it.

"Nope. Just came by to say hey."

She paused with a butter pat on her plastic knife and gave me a smile. "Well, hey!"

"I can come back later. Really I was just stopping by to visit with you. Believe it or not, I had some extra time and thought I'd spend a little more time with you. You look like you're about to throw down so I can come another time."

"If you don't mind me eating while you here, I don't mind at all. Matter of fact, that make me feel kind of special that you here." She bit into her buttered roll and then stopped. Pointing the piece of bread in my direction she said, "Don't you be on television?"

"I used to be on every week. Not as much now."

"I knew that was you," she replied with a mouthful of food.

"Yes, ma'am."

So for the next few moments I simply sat next to her bed as she dug into the "double portion" that we'd ordered for her the night before. Whoopi Goldberg was fussing at that Elizabeth Hassel-something-or-other on The View and Barbara Walters was rolling her eyes. I never watch that show but felt convinced that every single time that I have that this is exactly what is happening no matter what the topic of the day.

My patient asked me to call her by her first name as soon as we met. "Call me Sheila," she'd insisted after my standard last name greeting earlier in her hospitalization. Even when I responded by calling her "Miss Sheila" she quickly corrected me by saying "Sheila is just fine."

Sheila it would be.

Sheila seemed a lot older than her age. It was like she'd lived her life in dog years, cramming a centennial's worth of hard knocks and horrors into her four decades. Her upbringing had been "rough" as she described it and the last twenty years revolved around her addiction to crack cocaine. She had "some kids" and "some grandkids, too" -- none of whom were in her custody. When she told me that--let me tell you--her lip didn't quiver not one bit, nor did her eyes water. This was her reality. Those tears had dried up long before.

"Do you remember the very first time you used?" We'd been talking for a while at this point so I figured I'd ask. It's a question that I'm always curious about. The first time--how did it happen? Or even what was going through the person's head?

Sheila wasn't a fifty-something or sixty-something year-old. She wasn't of that age that shake-shake-shaked their booties in discotheques in the seventies, tooted powder lines to feel relaxed, and then took a naiive hit of this "new stuff" called free base. She wasn't a part of the era that got blindsided by the crack cocaine epidemic as it unfolded on urban street corners in the eighties--making squirrelly gangsters uber-rich and working poor folks disturbingly poorer.

Nope. Not her. She was of the age that I was. Plus or minus no more than three years. The age that turned on televisions and heard First Ladies telling kids to "Just say no to drugs!"  Like me, I bet she probably sat cross legged on the floor and sang along with that infectious "GET HIGH ON YOURSELF" NBC jingle aimed at little kids like us, imploring us to believe that "being high on yourself" is actually rather cool.

Maybe. But my point is. . .she came up in the era that had been given the memo. The genre who cringed at the eighties movie Less Than Zero and who still try to shake those awful scenes from that movie from our heads when we see this reinvented version of Robert Downey, Jr. in movies like Iron Man. And even if she didn't see any of that, kids our age were told. Crack is bad. It's addictive. It's whack. Don't use it. Don't touch it. Or else.

So why? So how? How did that first time happen? How could it have happened even?

Her answer was pretty nondescript. "I was nineteen and it was a bad day," she said. She left it there.

"A bad day?" That was it? That was all? I wanted to know more.

Now she was slurping her coffee. She winced on the first sip and I suspected that her fractured teeth were sensitive to the temperature. I was glad that she didn't seem annoyed by my queries. In fact, she seemed to welcome them. "I left home when I was like fifteen. I was working on the track from sixteen on. That was rough, you know?"

"The track?" I'd heard the term before but I wanted to get clarity just to be sure.

"You know. The track. Where you walk to get picked up. That's where they drop you off and where the girls go when they, you know." She made a rolling gesture with her hand to fill in the blank. "You know."

You know. Sell their bodies.

Sigh.

"You were sixteen? Damn."

"Yeah. Sixteen is hot on the streets. Fifteen even better. I looked-ed young so they was at me tough. First I was a renegade, then I got chose so I had some protection."

"Chose? Like you got a . . .pimp?"  It almost felt cartoon-like to say it aloud. I'd never uttered the word "pimp" to someone in the context of them really, truly having one.

"Unnnh hunnh." She hitched her breath again after a little more coffee passed over her lips.

"What's a renegade?" I continued. This one I didn't know and hadn't heard.

"That's when you just on the track and ain't been chose. But that's dangerous."

"So like. . . .where is 'the track?'"

That made her laugh out loud. "You funny, doc. The track is everywhere that it's girls walking. Or the boy-girls 'cause some people into that, too. Every city got tracks. It just depend on what you looking for, you know? Like if you want young girls, big girls, white girls, black girls, boy-girls. You go to that track. That's before the computers, too. Now it's kind a different but they still be out there getting they money on them streets. Getting that paper!"

The whole thing made me shudder. At sixteen I was crying after a bad experience with my first pelvic exam. That was as close as I'd ever been to being penetrated and here she was--around the same point in time--getting penetrated over and over again to stay alive. I tried to look calm, like this was talk I'd heard all the time. It wasn't, though. It so very wasn't.

"It seems like you had a lot of bad days before you turned nineteen, though. Wow."

"You know? When you don't have no family, the girls become your family. We used to be close and have fun together. People don't think that but we did."

"I can see that."

"I got tired. Tired of doing that all the time and I had been thinking about trying to get out the game. But that's hard." I leaned my chin on my hand and stayed silent. She went on. "My daddy had good girls. We was all young and fine and pretty, too. Them dudes stayed at us, they always wanted his girls. He kept our hair did and us looking nice. But he didn't like it when you got messed up. Like if you got old or too big or whatever. He also didn't like no crackheads."

I was confused for a moment but then a light bulb came on. She said she wanted out. It was hard to get out. And her "daddy" didn't like when his girls got tied up with drugs? I hoped she wasn't saying what I thought she was saying. "So. . . .you said it was a bad day?"

"I had got hit by this dude and he robbed me. And my jaw was hurting but he put me right back out on that track. The fiends was always out there and the hustlers was out there serving 'em. They didn't bother us 'cause the crack fiends always would do stuff for a hit so they didn't need to be bothered with us. And that day, I was just like eff it."

"Eff it?"

"Yeah. I bought a rock and smoked that shit. Sure did. Smoked some more and just like they say, I wanted more. My jaw didn't hurt, my feet didn't hurt, nothing. Next thing I know, I was hooked. Spending my money on it and just waiting to get my ass whooped for it."

"Did you?"

"Hell yeah! Almost left me for dead. But you know what? That's how I got out. He fired me when he found out I was a fiend."

"Wow." I didn't know what to say or ask next. Trading in prostitution for crack addiction sounded like the same kind of choice given to people inside of towering infernos--jump out from a twenty-story window or burn to a crisp. Both are equally shitty options. I wiped my face to get that out of my head and went on. "So. . . when you . . got fired. . . like. . . how did you feel?"

She paused for a second and thought before answering. "Sad, a little bit. Because I missed my other girls. But relieved, too. I mean, I knew how to get money. Now instead of money it was just rocks, you know, to get high."

And all through this conversation she kept doing mundane things like sipping coffee and sprinkling pepper which was really off-putting. It made the dichotomy between our lives just that much more palpable; her everyday existence so far, far away from my own.

"I'm sorry."

She shrugged once again and smiled at me with those decaying teeth. Behind the matted hair and weathered skin, I could see flickers of that once beautiful young teen. I mourned her loss and wished someone had been there to protect her. Instead, all I could do was hear her truth and recognize that there are lots of harsh realities going down right here, right now in the United States of America.

"You sorry? Shoot, I'm sorry that I got to wait until five o'clock to get some more food!" She announced that ironic response while covering the plate again. "Or that Sprite ain't on the menu." She laughed a raspy laugh that somehow gave me another pang in my stomach.

"You want some Sprite?" I asked.

"Yes. But in a can, not a bottle. It's colder in a can."

And with that, I stood to my feet and went to do just that. Because Sprite in a can was something I could do. I couldn't just pop some quarters into her universe and wait for a new life to pop out of the bottom. But an ice cold lemon-lime soda from the machine in the family waiting area? That I could do.

When I came back to her room, she had already nestled under the covers and was dozing off. I gently placed the can of soda on her tray table and grabbed a napkin from her tray to leave her a note.

Thanks for letting me visit with you and for telling me about your life. Here is your Sprite. I hope it's still cold when you wake up. 

Dr. Manning

When I prepared to walk out, the last thing I heard was Whoopi Goldberg still fussing at somebody on The View.  I hit the mute button on the side of her bed, pulled the divider curtain, and then went on with the rest of my day . . . . marveling at what can happen but for the grace of God or for the luck of the draw--whichever you believe in.

***
Welcome to Tuesday.

And now playing on my mental iPod. . .first, the talented Ms. Mary J. Blige singing "My Life." It made me imagine Sheila singing it with her raspy voice and just as much soul. (I always have to stomp my foot and say, "You betta SING, Mary!" when I hear this song.) Turn it up and you will, too.



Second. . . .the ridiculously cheesy 1981 "Get High on Yourself" commercial -- check out all the celebrities back then! I was in the fifth grade when this came out and my best friend and I sang it on the bus every single day.



And lastly. . . . I'm just saying. . . Clint Eastwood didn't just start going off the script. . . peep this from the unveiling of Nancy Reagan's "Just Say No" campaign. 

Systole and Diastole.

 sys·to·le (sis-to-lee) n.

The rhythmic contraction of the heart, especially of the ventricles, by which blood is driven through the aorta and pulmonary artery after each dilation or diastole. 

di·as·to·le (di-as-to-lee) n.

The normal rhythmically occurring relaxation and dilatation of the heart chambers, especially the ventricles, during which they fill with blood.

 ____________________________________________________

The heart muscle contracts. It clamps down and gives momentum to the blood, moving it from atrium to ventricle and out through the aorta. Rhythmically tensing just enough to get things going where they need to go.

And also enough to keep them going.

They call this systole. 

And with systole, a lot of things have to work together. The pressure can't be too much or too little. Too much and the muscle starts to bulk up and will eventually tire out. Too little and the heart has to work double time to make up for it. The valves have to open at the right time and they must open all the way to let the blood through. Then, when it's time for them to close, those same valves need to shut tight and flush so that no blood escapes back to where it just came from. The atria and ventricles must work in concert.

For it all to go right and for us to stay alive, all of these things have to happen in perfect harmony.

But that's not enough.

Each contraction must be followed by a period of relaxation. A time that allows the blood to refill empty ventricles in preparation for the next contraction. Much like systole, this has to happen the right way. The muscle can't be too stiff. The pressure pendulum can't swing too far or too narrow in either direction. One part can't be moving while the rest is relaxing. It all has to be synchronous.

But most of all it has to happen. This period of relaxation must take place.

They call this diastole.

So today, I was just thinking about how work-life balance is a lot like systole and diastole. There can't be too much of either. Or too little.

For me, this is always a work in progress. On some days, I am a systolic all-star. Giving a talk at a conference, teaching on the wards, leading my small group, and revising manuscripts for publication all in the course of one week. I burn that midnight oil; I move and shake and watch things come together. I feel those slaps on my back and they serve as affirmations that I am getting it right and winning.

Winning. 

Sure. Sometimes my systole is so much fun that it tricks me into thinking it's really not that. But--whether it's fun or not--contract too much and it becomes palpable. Balls drop. That overwhelmed feeling starts to creep in. That's when I make myself get that necessary diastole. That time to regroup, refill and prepare myself to pump some more.

Yeah.

Now on the flip side, the relaxation thing can get out of hand for me, too. Just ask the BHE--I'm a master at putting off what I have to do for what I want to do.

Mmm hmmm.

And so. Much like the heart, the goal is to fight to get the right rhythm. Sustained. Rhythmic. Not too fast and not too slow. Not with too much pressure and not with too little. Contract. Relax. Contract. Relax. One and then the other. Not too much of one. Not too little of the other.

Just right.

Last week was a whole bunch of systole. Fun systole, but systole no less. I'm glad to love my work so much that the systole often masquerades as diastole.

So here are some images of my systole from last week. . . .

On 6A with Coach B's awesome daughter-slash-Grady nurse, Jessica!

The first take of my thumbs up for Leah--which looked like I was punching her instead!

Hugging Tammy, one of the best people in all of Grady history.

And of course, my bff David M.

This just made me think of something.

It's not enough to just have diastole. You have to take some time for yourself, yes. But just like the way it's necessary for the atria and ventricles to contract in sync, the same can be said about getting in rhythm with your loved ones. I think it's key to make every effort to line your diastoles up with the diastoles of those most significant to you.

Not every time. But as much as you possibly can.

Yes. Last week was one big ol' systole. But this weekend? Diastole, baby. Irrefutable, indisputable diastole. Three luscious days of it . . . . perfectly coinciding with the refilling periods of the ones who matter the most.

Lake effect sunshine in Georgia sure beats lake effect snow in Ohio!

With the one I love--my BHE.

Enjoying some non-medical literature--loaned to me by my Grady-girlfriend Stacy H.

Rehydration to prevent dehydration.

a face that makes me happy.

Synchronized diastole.

Part kindergartner, part T-rex.

Infectious joy.

Those swim lessons paid off.

Zachary was telling me that he won't forget me when he's a grown man. Swoon.

I believe him.

Their diastole includes electronics--which Mommy doesn't allow on school days.

I don't get it right every time. But sometimes? Man. Sometimes I get it right.

Food for thought:  

How are you doing with your systole and diastole? Are you lining up any of your diastolic moments with those who matter the most? And are they making the same provisions for you?

***
Happy Labor Day to those celebrating it. And Happy Monday to all o' y'all.

The Pride.

After her very first presentation of her very first patient on the Internal Medicine clerkship. She was a lion. And we were both proud.

Can't you tell?

Welcome to the pride, Leah. The best is yet to come.

***

Happy Sunday.