Dat'll do.

*Names, details, and all that stuff that folks worry about have been modified.

Piedmont Park on a Saturday, Atlanta

Last patient of the day on a sunny afternoon. This was back when our Urgent Care center was open on weekends and, no matter how much you love Grady Hospital, being there on a sparkling Saturday is not exactly ideal. So yeah, that's where I was but on this day I was trucking. Running three rooms, working seamlessly with the nurses, and stamping out disease one urgent complaint at a time.

I'd grabbed his chart and read the complaint. "Recurrent hemorrhoids and constipation." Age: twenty-something.

Now. If you are a doctor who has ever worked in a super-busy clinic--especially a super-busy inner-city clinic--you can totally understand why those two words "hemorrhoids and constipation" would make me do the happy dance. Especially at 4:45 P.M. on a weekend when I really wanted to be in Piedmont Park.

I nodded my head smugly and pointed at my colleague who was feverishly charting on his second to last patient of the day. "Yeaaaaah baby!"

"What? A toothache?" he asked. We both knew that a toothache was the motherlode of complaints that were in-and-out for us. As internists, there wasn't much more that we could do other than getting the patient to an area dentist or oral surgeon. Antibiotics in the interim and pain control could be written on a script quicker than you could say "Rumpelstiltskin." Next best thing? Hemorrhoids. Especially recurrent ones.

"Hemorrhoids. And constipation. Recurrent." I smiled a big wide smile.

He squinted his eyes at me and groaned. "I have someone with a headache and a pretty elevated blood pressure. At four forty-five. Awesome." He held up the other chart in his hand. "And this patient needs some stat labs."

"Ouch."

"I know, right? So much for finishing up early. But I guess we signed up for this, right?"

"Claro que si," I replied while sifting through the computer to see if my young patient had any old lab work. "No labs or prior visits to the Gradys." I stood up, propped hands on the desk and leaned over toward the window like a tripod. I was looking forward to feeling that sun on my face.

"Rub it in, why don't you!" my colleague teased. I raised my eyebrows and smiled again. Then he offered me a playful warning. "Hey Kim. . . . . nothing is ever as straightforward as it seems."

"Especially at four forty-five on a Saturday!"  I pushed the door open and chuckled again. Quickly I made my way to my last patient of the day.

After a knock on the door I stepped in and introduced myself. "Hey there, sir! My name is Dr. Manning and I'll be seeing you today. You are . . .Mr. Cole?"

"Yes ma'am," he replied while firmly shaking my hand. That handshake was deliberate and masculine. "It's okay if you call me Quentin, though."

"Is that your preference?"

"Sure. That's cool. I mean, yes ma'am, that's what I'm most comfortable with."

I liked the way he autocorrected himself when speaking to me. Almost like he could hear some grandmama in his ear saying, Is that how you speak to people? The Grady elders call that home-training. I could tell he had plenty of it -- from his neatly groomed hair and clothes to the straightness of his spine as he sat. No slack jeans or mumbling voice. He clearly had some quality home-training.

"Okay, Quentin. So . . .are you a student here in Atlanta?"  I couldn't help but ask since he was wearing a t-shirt with big block letters from his university on it. The baseball cap and drawstring nylon bag in the same color palette gave it away. That and his young face. "I see you representing your school with all the paraphernalia!"

He nodded proudly. "Yes ma'am. Proud of it, too!"

"Good stuff," I continued. "What are you studying?"

"Finance. And I'm on an athletic scholarship. Football."

"Nice."  And I said that because I meant that. It was nice that this kid with the home-training was in an excellent four-year institution on a scholarship. I looked back down at his chart and was reminded of his chief complaint. I knew it would be more awkward for him than it was for me  so I did my best to keep things light but formal. "So I see that you have a problem that isn't a new one for you. How about you tell me what's going on?"

"It's kind of embarrassing. But yeah, it's hemorrhoids. And since they are kind of uncomfortable, I think I've been avoiding doing. . . .you know. . . number two."

"Got it." I jotted that down and glanced back up. "Hemorrhoids are so super common. They can be pretty uncomfortable, too."

"Yes, ma'am." He seemed to appreciate that normalizing statement.

"You've had hemorrhoids in the past?"

"Yes, ma'am."

I stared at him for a beat and thought about why a twenty-something year old man would have recurrent hemorrhoids. Most of the time they come from straining--pushing out hard bowel movements, pushing out big babies and pushing through some heavy lifting. Heavy lifting? Aaaah. Yes.

"Do you lift a lot of weights for football? Like squats and stuff like that?" I knew that answer before he could even open his mouth. His percentage of body fat wasn't the kind you get from recreational work outs. He had that two-a-day practice kind of definition clear down to his calf muscles.

"Yes ma'am," he chuckled, seemingly relieved that we had an easy explanation for all of this.

I was relieved, too. Relieved that this was as straightforward as I'd hoped it would be, but also that I was sitting in front of a really charming young person who knew how to talk to other adults. His caramel complexion was almost identical to my own and his facial features even looked like those of people related to me. Something about that made me well with pride. I was glad to be seeing him.

"Is this similar to when you had hemorrhoids before?"

"Pretty much. They hurt a little more last time. Now they're mostly irritating." A wave of embarrassment came over his face. "I'm sorry. This is so weird to be talking about."

"Totally understand."

"I was hoping to get some of the foam and the medicine they gave me last time."

"That shouldn't be an issue."  I wrote down a few more things and then asked him some more obligatory questions. Like, what are you allergic to and do you smoke? Are you sexually active and have you tried any kind of drug? Do you drink and what medical problems besides this have you had in the past? His answers were predictable. No allergies, yuck to smoking, yes ma'am to sex and no ma'am to drugs. A little bit of asthma that he thinks he grew out of. Otherwise uneventful. Yes, this was all very straightforward.

Hallelujah.

I also asked a little bit more about the constipation and reviewed his diet. Typical crappy college fare, full of refined sugars and fats with a paucity of fiber. Duh.

Next was the physical examination. Habitually, I started with his eyes and oropharynx which didn't yield much of anything. Ears had not even a trace of wax and other than being hidden inside of an uber-ripped container his lungs, heart, and abdomen were pristine.  And then I paused.

Shit. He needs a rectal exam.

I could see his face pleading with me. It was saying, Please, ma'am. Just take my word for this. Please don't ask me to drop trow right here, right now. And you know? I strongly, strongly considered obliging him.

First of all, it meant I'd need to get a nurse to stand in as a chaperone. Since it was late in the shift, we were low on nurses so that would make the whole thing take longer. And seriously? This guy was a good historian with good home-training. Why wouldn't he just tell me like it was? Everything else about him had been easy-peasy. Was it really necessary for me to make this poor guy show this lady doctor his nether region?

I started coming up with arguments in my head. Telling myself that if this were some swanky private practice that this whole encounter could have been a call in to the nurse and that, sure, a prescription could be phoned directly to his local CVS. Or Rite Aid. Or whatever he so chooses.

But that isn't what this was. It was an urgent care visit. With a complaint involving the rectum. What kind of doctor would see someone for a complaint in an ear and not look at it? Grrrr. I could hear my dad in my ear. He calls that being a "dat'll do" kind of person. The kind that cuts corners just because they think they can.  I knew I had to look.

"Well let me just step out and grab a nurse, okay? Go ahead and undress from the waist down and cover your lap with this sheet. I'll be right back."

"Excuse me, Dr. Manning--umm. . . . is it possible to just make the prescription? My mom was saying that sometimes if you've had a problem before like this one -- especially a sensitive thing -- that I should ask."

I held my hand on the doorknob and paused. Good ol' Mama.

"She was saying, like, that her doctor if she has a yeast something she called it. . . . the doctor just calls it in or even takes her word for it. So she won't have to do that whole other part and get checked out all over again when they know what it is."

Damn. This was tempting.

Dat'll do. Dat'll do. Poopdeck wouldn't get out of my ear.

"This will be super quick. It's way easier than doing a pelvic exam. It'll take two seconds, okay? I'm only looking just to be thorough. I'll be right back."

I stepped out of the room before he (or me) could try to convince me otherwise. A few moments later I was back with Charlotte, one of our nurses. She offered a quiet introduction with only a smile and head nod.  Her job was just to be there and nothing else.

I instructed Quinten to put one foot on the step and to lean his body forward on the exam table. I kept reassuring him that this would be "super-quick" so that I could "quickly confirm that his hemorrhoid didn't need to be drained." He wasn't miserable enough to need emergent incision and drainage, but I felt the need to justify this mortifying position I had him in.

I rolled over on my stool to grab the neck of the positionable light and then flicked it on. "These are just my hands looking," I announced. Quentin's voice was quiet and far away as he mumble back an obligatory "Yes ma'am." I gently applied pressure outward to open the cleft and better visualize what was certainly going to be the tell-tale garden variety external hemorrhoid.  Just as I did, the bright light gave me clear view of the source of his complaint.

Or rather sources.

I'd been talking the whole time but now I was quiet. I looked carefully to make certain I was seeing correctly. And I was. Shit.

"Quentin? You said this was a little different than your hemorrhoids before?"

"Uhhh, sort of. I mean just. . .they didn't hurt as much."

"Um, okay." I inspected some more. "So, okay. How long has this been bothering you again?"

"On and off for like some months."

"Did the doctor who gave you the foam and numbing medicine last time do this kind of examination?"

"Like what you're doing?"

"Yes. Like what I'm doing right now."  This was awkward. Talking to someone who had their back--and their backside--to you. But this wasn't what I was expecting. I needed more history.

"No. It was my pediatrician while I was home for the summer. When he heard about me being constipated and the weight lifting he gave me the medicines and they kind of helped."

"Okay. Thanks for clarifying that, Quentin."  I went ahead and examined the rest of his genital region and then stepped on the other side of the curtain that Charlotte had pulled. "Go ahead and get dressed and we can talk about the plan."

"Yes ma'am." Of course. Yes, ma'am.

Charlotte was so busy that she was down the hall and into another task before I could even get out of the room. Moments later I stepped back inside to talk to Quentin about what I'd seen.

So what did I see? Well. It certainly wasn't a hemorrhoid. Instead, found a large collection of perirectal warts coalescing right at the entry. Some were pedunculated and red--I could see how this could be irritating to him.

I was mad at myself. First, I'd strongly considered not examining his rectum. Second, I didn't take a full sexual history. I"d gotten so caught up in making him a bread and butter case that I'd sized him up and forced him into my own story line. I was too experienced for this. To me, this was more the move of an overtired trainee. Not a full fledged attending physician.

Dat'll do. Dat'll do. 

"Quentin," I started carefully, "I didn't see hemorrhoids on your examination. I saw some pretty large genital warts at the opening of your rectum."

His eyes widened and his mouth fell open. "What?"

"It makes sense why you've felt this way. I think the medicines you took before quieted down the irritation but it probably wasn't ever a hemorrhoid."

"How did I. . . I mean, what does this mean?"

"I probably need to have a specialist see you. I can make a referral to help with that. I think since they're kind of big, they may want to remove them, like, surgically."

"Will that mean they're gone for good?"

I sighed because that was a damn good question. "Honestly? These often come back."

"Really?"  Now his eyes were glistening with tears.

"Quentin?" I softened my voice. "I should have asked you this earlier. You told me that you are sexually active. . . but are your partners female, male . . . or both?"

"Female," he promptly responded.

"Condoms? Do you use them?"

"Mostly. I mean, I've slipped a few times but mostly yes."

"Have you. . . .like. . . ever maybe tried sex with someone who wasn't a female?" It felt so lame to ask again but this diagnosis suggested unprotected anal receptive intercourse. We needed to get this out on the table before I could get to any problem-specific patient education.

"I tried it, yeah. Like only a few times, though."

"Okay. There really isn't an issue with whether or not your partners are only girls or only guys or girls and guys. The issue is mostly whether you use condoms. I think maybe one of the times that your partner didn't use a condom. . . .you might have gotten these warts around your bottom."

"Damn it! Really?" Now tears were falling down his cheeks. "So anybody who sees this on me will know, right? Like know that I've done that before?"

"Quentin, look. I know this is a lot and those kinds of questions are really complicated, you know? But to be honest, this can be as private as you keep it. There's probably more to all of this, I'm sure. Like, how you feel about all of  this and even how you feel about who you are."

"Yes, ma'am."

"My impression of you when I first met you is that you seem like a really respectful young man who obviously has been hitting the gym and the books." He offered me a tiny smile. "This is kind of crappy news to get on a weekend, but you're here, you know, and now you'll get the care you need."

"Yes, ma'am." He sighed hard and pressed the heels of his palms into his eyes.

"It's going to be okay, Quentin. Okay?"

He nodded and tried to believe me.

I wanted to say dat'll do and end it there but I knew I had to consent him for an HIV test, further screen him for other sexually transmitted infections, talk about safer sexual practices and arrange some referrals. He was gracious with all of it, and mostly he looked kind of relieved. Almost like I'd rubbed a genie out of it's bottle whose contents had been under pressure.

After all of this was said and done, the encounter was still pretty fast. I was out of the hospital by five thirty and yukking it up with a girlfriend over frosty margaritas on a patio overlooking Piedmont Park by five forty-five.

Yep.

I never saw Quentin again. I did see that his HIV antibody was negative and there were indications from his chart that surgical follow up was obtained. Otherwise, I'm not sure what ever became of him.

My guess is that he's somewhere working in finance and doing great things. I hope that he's being true to himself and not just saying "yes, ma'am" and "no, sir" because he thinks that's what everyone wants to hear.

But mostly I hope he's happy.

I never, ever forgot the lesson he taught me in not sizing people up with sweeping generalizations and also about fighting the temptation to cut corners. It's all so easy to fall prey to, you know? He also reminded me of how hard it is to be your authentic self in this world. Sometimes life nudges us to walk the seemingly easiest path when doing that really makes things less so.

Dat'll do. Dat'll do. 

No ma'am, no sir, it will not.

***

Can't get this out of my head.

Did you see this last night?

This has been playing on my mental iPod (and my real iPod) ever since I woke up on the couch in the middle of this artist Frank Ocean's riveting SNL debut. Something about the whole thing. . .the falsetto, the lyrics, the  emotion in his voice just grabbed me. It shook me awake and made me pay attention. (Especially once I realized that it wasn't Billy Ocean on an old school throwback.)

Yes, I realize that the song is kind of popular. But I guess I didn't realize it was SNL popular. And  hearing him sing it live without too much going on in the background made me hear it differently. Or better yet, actually hear it.

It won't ever get old, not in my soul

Not in my spirit, keep it alive

We'll go down this road

'Til it turns from color to black and white

Or do you not think so far ahead?

'Cause I been thinkin' 'bout forever 

Or do you not think so far ahead? 

'Cause I been thinkin' 'bout forever 

When I first met Harry, after our first date I called my father and told him flat out:

"Daddy? I think I've met my husband." 

And I was right.

Man. Those words resonate with me. Harry and I sat in the sunroom talking about this song this morning over coffee. Sure, I had to endure at least thirty two counts of him squenching his eyes and singing the falsetto parts but I also got to hold his hand and tell him how much I love thinking far ahead with him.

And he said he feels the same way.

From that first date, I thought far, far ahead. Man. I still do. I see us as empty nesters and then grandparents. I see us as crotchety and cantankerous old liberals who type crazy comments on message boards. I see our lights off at 9pm and us dressing up to go to doctors' appointments. . . then coming home at three PM and telling the middle-schoolers who just got off of their buses to get off of our lawn. I see all of that. And I see all of the extraordinary and ordinary things in between.

That song is kind of haunting because that's a scary thing to do to yourself. Thinking far ahead, you know? Like what if something happens, right? That's what the little voice warns you in your ear. I've heard the Grady elders say a million times: "Man plans and God laughs" but I just want to ask them . . . how can you not help but think so far ahead when real, true love presents itself to you? 

You can't.

So me? I'll sign up for the vulnerability that comes with those daydreams. Because it also means you get the delight of waking up and realizing that the thing you crossed your fingers behind your back and hoped for came true. You didn't jinx it. It's real.

Does that make sense to you? Please say it does and please tell me someone else does this in their head.

Or do you not think so far ahead?

Okay. I'm going to bed before I make someone barf all over their computer. Ha ha ha . . . 

Yawn. Nighty night, y'all.

***

Runners and gunners.

*Names and deets changed. You know the deal.

gun·ner (n.):

A person who is competitive,overly-ambitious and substantially exceeds minimum requirements. A gunner will compromise his/her peer relationships and/or reputation among peers in order to obtain recognition and praise from his/her superiors. (courtesy of urbandictionary.com)


_____________________________________________________

She was standing there with a stack of photocopied medical records shuffling them in front of me. Her glasses kept slipping down on her nose, partly because of their size but mostly because of the thin film of perspiration covering her face. The tremor in her hands seemed more pronounced because she was holding those rattling papers. I put on my most reassuring expression to help her relax but it wasn't working.

I suppose the whole thing was a bit nerve-racking. I mean, here she was a medical student presenting a patient to the attending on her first week of the Internal Medicine hospital service. At Grady Hospital, no less. For whatever reason, this rotation along with Surgery, are the ones that bring out the most nerves and insecurity in the students. I think it's because they are considered by many to be the "bread and butter" of everything else in medicine.

It was also a pretty big team that month. A senior resident and two interns, of course, but also three additional students not counting her. One was a fourth year who was nearing the end of residency interviews. He'd already decided on a career in Radiation Oncology and that fact, coupled with his experience, made him the most at ease of the medical students. Another student had been off cycle after earning a PhD. This was one of her final rotations so she, too, was mostly confident on rounds.

Then there were the other two. Seth and Parul. Both had just started the clerkship and were clearly neophytes when it came to the hospital service, but that was where their similarities ended. Seth, the one who wasn't presenting at the time, had enough swag for every member on the team. He was smart--and he knew it. All others in his presence had one choice and one choice only--step your game up or get your game stepped on. I liked how bright and enthusiastic he was but there were times that it seemed like he broke the code of "what's cool" when it came to his fellow learners. I didn't know how to feel about that.

Parul was pound-for-pound just as smart as Seth. I'd had a few brief encounters with her during the pre-clinical period and knew from those interactions that she was wicked smart. Somehow I'd gotten wind of the fact that she'd come to medical school on an academic scholarship and that she'd stealthily knocked nearly every test--including the boards--clear out of the park. Interestingly, she kept all that mum. No one would know how well she was doing from casual interactions because her confidence had it's "near empty" light on just about every time you'd see her.

So on our morning rounds, Parul walked bumpily through her patient presentation and it was mostly bumpy because she inserted an "um" between very other word. Otherwise, her information was well organized and quite fluid.

I make a point of treating the students as real, true clinicians and members of the team. I ask them the same management questions as I'd ask the interns--particularly when it comes to their opinion of what to do next. Parul's plan--though um-filled--was wrapped pretty tight so I didn't have too many questions at the moment.

"What do you make of the acute kidney injury?" I asked.

Her face quickly flushed and she swallowed hard. The pregnant pause was awkward, so again, I did my best to allay her nervousness. Finally, she parted her mouth to speak, but just as she did Seth spoke.

"Didn't you mention that she takes a diuretic? The hydrochlorthiazide could explain the AKI."

Parul cleared her throat and offered Seth an anemic smile. Instead of looking at her, he smugly looked at me to see what I'd say next. The resident started to say something about the diuretic but I put my hand up to stop him. With my attention on Parul, I nodded in her direction.

"Well," she started, "I did, um, consider the thiazide as a possibility. She was prescribed this three months ago, so that is a consideration."

"She's also hypercalcemic." We all looked at Seth who added this little pearl of information while holding not even a single sheet of paper. "The HCTZ could cause her some decreased calcium excretion, too."

I tried not to look annoyed with Seth but I was. I turned back to Parul and made myself more clear. "I want to know what you think, Parul. What are your thoughts?"

Again that lumpy silence as she carefully sifted through her words. And then, she put her own pieces together.

"I am not so sure about the thiazide, Dr. Manning. She wasn't taking them because they made her have to urinate too often and she catches two buses. I counted out her pills and the bottle was just a bout full. And it was dated from two months ago." She looked around with trepidation and then continued. "She is hypercalcemic--as high as 10.6--but I saw in her records that this preceded the hydrochlorthiazide."

"Okay," I said. "So what else did you find out?"

"That she's anemic," Parul quietly reported. "Her colonoscopy was negative and she was borderline iron deficient. She also had proteinuria on her urine dipstick in the ER and an unusually high protein against that albumin level."

"So you're thinking multiple myeloma? Makes sense." Seth had jumped in again. I sucked in a deep breath in the most subtle way I could. What I really wanted to do was grab him by the collar and tell him how uncool it was to steal her punchline like that.

"Well, duh!" I chided him. "Obviously that's what she's getting at. What's up with you jumping in on the punchline, dude?" I couldn't resist saying something. He laughed but still looked uber-confident.

"So, if it's okay with you, I think a serum protein electrophoresis might be indicated," Parul went on.

"Makes perfect sense." I smiled at her and put my hand up for a high five. She timidly met my open palm with hers. "Anything else?" This time I was glancing toward my resident and the rest of the team.

"Well, we could also check for HIV or hepatitis C," Seth mentioned. "That could also explain the gap between he total protein and albumin."

"Good thinking," Parul responded quietly.

"Has that been checked at all?" I had to know.  I knew that Parul knew this patient well and was willing to bet that she'd already thought of this. She was such a good citizen that instead of neck rolling and fingersnapping in Seth's face like Honey Boo Boo, she simply smoothed it over by letting him look  good -- even though he'd repeatedly been doing so at her expense.

"They were checked, Dr. Manning. Both were negative."

"Got it. Thanks, Parul."

So we finished up our rounds and that same kind of thing played out two or three more times with Seth one-upping his comrades with these medical booms he repeatedly lowered on them. Every point he made was a good one. But the issue was how he did it.

Not cool.

I pulled Seth aside later that afternoon. I told him that I could tell that he was bright and that he enjoyed learning. But I also told him that he needed to be more savvy about how he interjected his medical knowledge while another had the floor.

"There's a way to do it," I told him. "You want to be collegial, you know?" So I gave him examples like the whole deflating interruption about multiple myeloma and his insistence on getting the last word on other discussions. "Be careful," I said. "Medicine is a team sport."

"So am I just supposed to stand by passively? Not speak up unless it's my turn?"

"No. That's not what I'm saying. Not at all."

He furrowed his brow and looked annoyed. Annoyed in that "you're really just insecure so this is why you're saying this and not because I was treating my classmate like an asshole" kind of way.

He let out and exaggerated sigh and countered my statement. "Soooo. . . .if I hadn't mentioned the diuretic, I'm not sure it would have come up."

"Of course it would have. Seth she was still in the middle of her assessment and plan. You never gave her a chance."

"I mean. . . .she was just standing there hemming and hawing. I'm here to learn. This is frustrating to hear because speaking up on rounds helps me to learn. I can't help it if no one else wants to speak up."

I paused and tapped my fingers on my lips before speaking. "It wasn't that you spoke up. It was how you did, Seth. It was how."

What happened next was something I had never done. I commenced to give him a series of suggestions -- specific suggestions -- for other things he could have done and said that didn't undermine his colleague. Such as looking in her direction when speaking. Or letting her finish her thought before jumping in. Maybe even asking her, in a collaborative way, instead of a way that trumped her thoughts.

But especially not sucker punching her with extraneous information on her own patients in front of the attending. Not. Even. Cool.

"She hadn't mentioned the calcium level. How did you know the patient was hypercalcemic?" I asked him. This was probably the thing that was making me the hardest on him. I had the distinct impression that he'd looked up the labs and prepared to share facts that Parul hadn't mentioned. All in an effort to look good.

"I look up all of the labs for all of the patients every day," he said. "I'd seen it the evening before so thought I'd mention it on rounds."

"Did you think of mentioning it to Parul that morning? Like in case she didn't know?"

He was quiet.

"That wasn't really cool."

"I guess I was trying to put the patient first."

"Were you?"

"I . . .I mean, I just wanted to make sure we thought of everything. I thought me looking up labs and thinking about people other than just my patients would be helpful. Some call it being a gunner. I just call it trying hard and holding myself to a high standard."

I pressed my lips together and raised my eyebrows. I gave myself a five second countdown before speaking to make sure my words were chosen carefully.

"Look, Seth. I'm actually okay with 'gunner' medical students. I don't mind it when you're reading and going hard in the hospital--in fact I welcome it. But be a gunner for the patients. Knock down doors to advocate for them and to get to the right diagnosis. You can do that and be collaborative with the people on your same team, you know? Gun all you want on my team. Just gun for patients. If you're gunning for the patients, you don't have to step on toes to look good. It's just a by-product of your efforts."

"I wasn't trying to step on toes." For the first time his voice was small.

"Whether you were or you weren't, you kind of did today. You could have shared your thoughts with Parul before she presented her patient. Or you could have waited until she finished the entire presentation. I always open it up for others to share their ideas at the end."

"That's fair."

"Good." I reached out and shook his hand. "Medicine is a team sport. You got that?"

He nodded like he got it. Something tells me he did.

Later that week, I spoke to Parul and coached her on ways to be more confident in her knowledge. I commended her for counting those pills and reading the bottle dates. I also gave her props for data mining in the chart and thinking carefully about that patient. Then I told her about the night that my fellow in the NICU encouraged me to be a lion and also the night that Ida, the MICU nurse, saved my life (and a patient's) by nudging me to take the lead on a code way back when.

"We're going to work on your confidence," I told Parul in closing. Because in medicine, that's important.

I guess I've been thinking a lot about coaching and encouraging these days. It makes such a big difference. Don't you think so? I do.

So the rest of that month went really well. Parul and Seth worked well together and grew in their mutual respect for each other. They worked in concert and pushed each other to step their respective games up without tearing the other down. And that was a really, really good thing to witness.


It's funny. Confidence and competence are almost always mismatched in medical training and sometimes beyond that, too.

On second thought, that's not really very funny at all, is it?

Hmmmmm.

***
Happy Sunday.

Own your space.

And understand I got the gift of speech

And it’s a blessin,

So listen to the lesson I preach

I talk sense condensed into the form of a poem

Full of knowledge from my toes to the top of my dome

I’m kinda young--but my tongue speaks maturity

I’m not a child, I don’t need nothin for security

I get paid when my record is played--to put it short

I got it made

_________________________________________

I always liked the bravado of that song but I can't say that I always feel that way myself. There are days that I feel lackluster. Like my best isn't good enough or rather my best is in there somewhere but I haven't pulled it all the way out. A spiral of self-doubt sets in. I double-think my moves. Some insecurity sets in. The little voice goes to town and pounces all over me until I'm flailing on the ground.

Yes. This happens to me. More often than one might imagine.

But I have this mantra that I say in my head when I start feeling that way. I pair it with my "already enough" cheering section and then I put my dukes up and start that metaphorical shadow boxing. As I feel my pulse quickening and my face feeling warm from angst or second-guessing that's when I start shouting in my own ear.

OWN YOUR SPACE.

Own your space. What does that mean? Well, I can tell you what it means to me. It means that I'm the only me that exists. It means that I have something unique to bring and am the only one who can bring it in this "me" kind of way. In other words, the space that I have been given to do me is mine. And I need to own it.

So I prepare. I self reflect and reassess and try to do my best. The old school rappers called this "show'n'prove." Sometimes you just have to show'n'prove to yourself that you got this. That you're enough. That starts with owning your space.

I was teaching in the clinic the other day. It was just one of those days where you feel like you're flying on one wing, you know? And that little voice started telling me that my teaching points weren't good ones and that I wasn't as great as I people thought. That's when I literally stepped out of the room and faced a window with my eyes closed.

You are enough.
This is your space. Own it. You are a great teacher. You are an awesome communicator. You're good with people. You have experience. You're the only you they can work with. So own that. Own it.
Own your space.

That took me approximately twenty seconds. But when I returned I had a different vigor. I felt good. I felt able. I was reminded of who I am.

I am not perfect. But I am an excellent work in progress of the only me that exists.

I also told these words to two different medical students this week. Simple advice that I give myself:

"Own your space."

So today I am walking in authority. Knowing that I am enough and that this space I've been given to live in -- this little circumference around me -- is my space. And, dammit,  I will own it.

The enemy is often ourselves. Even if others around are poisonous, we first have to drop our guards enough to let them in.  No one will taint your space without your access. That means we can't blame others when those doubts creep in and what it really means is that it's all on us to fight.

Fight! Rage against our own machines.

Does it mean perfection? No. Mistakes will be made. Revisions will be necessary. And that's fine and good and as it should be. You wake up to a new day. You shadow box. You show'n'prove.

Yeah.

What am I even talking about? I don't know.

You know? Something just tells me that this is a word someone needs today. Any time I wake up with something like this on my mind I've come to learn that someone else under the same sky is feeling the same way.

So today I will tell you the words I constantly tell myself:

You are enough.
You are the only you there is.
Walk in that authority.
Own your space.

Only you can decide what that means and how you'll use it to show'n'prove. And once you do, you'll have  it made.


That's all I got this morning.

***
Happy Saturday.

Now playing on my mental iPod. . . .this old school hip hop cut always hypes me up.

Top Ten: I came to dance, dance, dance. . . . .

on Wednesday with Lisa K.

I came to dance, dance, dance, dance

I hit the floor

'Cause that's my plans, plans, plans, plans

I'm wearing all my favorite brands, brands, brands, brands

Give me some space for both my hands, hands, hands, hands

Yeah, yeah

'Cause it goes on and on and on

And it goes on and on and on, yeah

I throw my hands up in the air sometimes

Saying a-yo

Gotta let go

I wanna celebrate and live my life

Saying a-yo

Baby, let's go

~ from Taio Cruz' "Dynamite"

________________________________________________________

Man. It was quite a week. Some parts were eventful. Other parts less so. But overall I'd say my first full week as a forty two year-old woman wasn't too bad at all. The high points outweighed the annoying points, that's for sure.

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

THE TOP TEN PARTS OF MY FIRST WEEK AS A BONA FIDE FORTY TWO YEAR-OLD GROWN ASS WOMAN

Leh-go!


#10  Refreshing!

Okay. So usually I don't go wandering up into Starbucks too often because I'm a little on the cheap thrifty side. But! When you have a birthday, people do things like sliding Starbucks gift cards into your birthday snail mail (Thanks, Crystal!)

And so. Armed with my free-to-be-frappachi(no) gift card, I rolled up into the Starbucks in Emory Village. The barista (why do we have to call them that?) asked me what I wanted and like always I got mad overwhelmed.

"Uhhhh, errrr, ummmm. Let's see."

"Something hot or cold?"

"Errrr, yeah. Okay. Cold."

"Caffeinated or not?"

"Neutral."

"Milk based or not?"

"You definitely don't want me to have any milk, bruh."

"Have you tried the refreshers?"

"The who?"

"The refreshers. Cool Lime is my favorite. And it's low calorie and no added sugar."

"No milk?"

"No, ma'am."

"Bet."

"Huh?"

"Oh sorry. That's slang for 'let's do this.'"

"Pardon?"

"I'll have the Cool Lime Refresher. Dang."

"Tall, Grande or Venti? Or Treinta?"

"Surprise me."

"How's a Grande?"

"Bet."

Wait. What's the point of sharing all of this? None whatsoever. I just want y'all to know that the Cool Lime Refresher is like a citrus party on your taste buds. Kind of like a guilt-free collision between a mojito and some lime juice without the rum.

Yum. And to think I have nearly twenty more dollars on my card. WOOT! WOOT!

#9  Do it for the story, man.

Okay. You know of my obsession with flash mobs. Clearly I have been waiting for the big moment to arrive where I got to either witness one or -- GAAAHH!!! -- be in one. And y'all! That big opportunity finally presented itself. YES!

Aren't you just SOOOO excited at the idea of me getting to be in a flashmob? I know you are!

Well. My friend Lisa K. teaches my step class and Body Pump classes at the Y--but she also happens to be the coordinator of wellness at an assisted living community. She's been working on a project about active aging and wanted to put on a flash mob with people of all ages. And so she started planning and, of course, called her flash mob obsessed friend to join in the fun.

And so. We learn the moves. We wear the requested colors. And we arrive in downtown Decatur at the appointed time. That appointed time was twelve noon on Wednesday and it turns out that there are a whooooole lot of folks that are actively aging in the Decatur area.

Like a whoooole lot.

So check it. You know how in a flash mob one person just randomly starts dancing and then others surprisingly join in -- astounding everyone with their knowledge of the choreography? Well. It turns out that the senior flash mob works a bit differently. And by differently I mean that at noon everyone got in their places and stood there with frozen jazz hands waiting for the music to come on. Like for at least two full minutes.

And me?  I'm all like, "HEY! You're supposed to just inconspicuously walk by and then break out with the moves! Stop with the jazz hands. Look normal!"

And the man I told was all like, "Vaaaaat?"

"Normal!"

"VAAATTTT?"

So I tried to explain again and he just kept saying the same thing until the music came on signaling that it was time for him to get his groove on. So all the jazz hands started moving in very slow, happy unison and as soon as we did, I was immediately super glad that I was there. Hell, even if we didn't surprise anybody with our sneak-attack choreography we were at least a mob. Even if we weren't a flashy one.

My favorite part was the seventy-seven year old woman next to me who was shouting out all the moves along with a constant eight-count. And she was mad loud, too, kind of like the lady on Dance Moms.

"Shuffle-one, two, three, down-four, five, six, shimmy-on-the-eight!"

And if you are clapping your hands and saying, "That's AWESOME!" while cracking up laughing. . . . know that it was twenty times more blogworthy than it even seems here.

Seriously, though? It was really fun. Talk about doing something for the story.

P.S. I'm still looking for a big ol' complicated flash mob to be in. If you get any ideas, holla at your girl.

#8 Salon on a Sunday!

Okay, so no. I didn't really get my hair done on a Sunday. But! The salon girls took me to a casual breakfast on Sunday. My awesome stylist Sakinah bought me a delicious mimosa and we all sat and yucked it up just like in the salon. We talked junk and discussed everything from politics to whether or not TJMaxx is more exhausting than Ross for Less. (Answer: Nothing is more exhausting than Ross.)

All we needed was a dude to walk in selling some peach cobbler and it would have been exactly like the beauty shop.

#7  Twenty years later!

We all met each other back in 1992 as first year medical students. Now, instead of young girls from Tennessee, California and Georgia, we're grown women with kids and doctorates. We reminisced on the crazy things we got into as med students and tried our best to get our minds around how we did anything social in the pre-cell phone era.

Those were the days!

#6  Good-byes SUCK!

I've been in denial about this. So much so that I haven't even uttered it aloud because it seems real when I do. My dear soul-friend David M. is leaving Grady to go work in Philadelphia. It's a great opportunity for him and I'm happy for him. But sad for me! Sad for me!

Yeah. So we had a going away dinner for him last week. It was cool. But I was sad. I still am.

#5 Cupcake Red Velvet!

I tried this for the first time because people kept telling me it was yum-tacular.

I concur!

#4  Drive-by Teaching

I snapped this picture today of one of our former residents doing some teaching and consulting on a complex EKG. Sonny--the one reading the electrocardiogram--is someone that I've known since his first day of internship. Seeing him now as a Cardiology fellow advising my colleague Schuyler and teaching all of us something that we didn't know warmed my heart. I love being in this kind of environment.

#3  These pictures are just cute.

I usually don't think they look alike. But here? Dang. They really do.

#2  Tuskegee Girls.

On Saturday, I spent some time with my sorority sisters. Sonya, who pledged with all of us, turned forty and had a big ol' party. Of course it was fun. It's always fun when we all get together.

#1 Look out Peyton and Eli. There's a new Manning in town.

Before anyone asks--yes, I am okay with my child playing football. Let's just stop there with that line of questioning and any worry-wart commentary that may or may not be tickling the tip of your tongue.

It took everything in me not to tackle him to the ground with smooches.

Okay. Where were we? Oh. Football! Yes! Can I please tell you how fun it is to be a football mama? Oh my GOSH. It's on a whole 'nother level! The energy is SO amazing, y'all.

Seeing him come in from practice all hungry and sweaty makes my heart ache. Something in my mind just fast forwards to him being a high schooler sitting at my same table.

Harry's a coach--and he really gets into the spirit. Peep those socks! Lawd.

And what's also SUPER awesome about all of this? Isaiah. He flat out expressed no interest in playing football but was fully supportive of his brother's desire to do so. (Isaiah says that he's "a fan of the feet and not of the hands" so has chosen to stick with soccer.)

Future David Beckham and Cam Newton

Look how laid back and genuinely encouraging he looks here. I just love that about both of them. They have their own interests. They are developing their own self images and marching to their own drums. Zachary announced that he wanted to play football this year. And since we love team sports for kids and grew up on them, we found a well organized league for him to join.

Y'all! He's fast, too!

And that Isaiah is playing soccer and also asked to join the Chess team. Which he sure did join. (Despite the fact that NO ONE in our house other than him knows the first thing about how to play chess.) Zachary made it very clear that he preferred anything other than the Chess club but he, too, listens and encourages Isaiah when he shares all the details.

Yep.

I just love this phase of life with my kids. I'm enjoying watching them discover who they are and what they love. I love seeing them try at things and hearing them discussing it when they're supposed to be fast asleep. These are special times.

Whelp! Gotta go to bed so that I can rest my vocal chords. Lots of hollering goes on at those games. And just a wee bit of trash-talking!

***
Happy Almost-Saturday. And may the Flash-Mob be with you.

And now playing. . .Zachary's favorite, favorite song.

Words on a Friday.

Well, hello.

Sorry I've been a delinquent blogger. But that's the last I'll say on that because I find it rather annoying when bloggers blog about not blogging.

Oh yawnity-yawn-yawn!

I've been in the throws of writing letters for medical students who are applying to residency programs. Deadlines are looming and I get pretty crazy over the letters since I know that a lot rides on my words. I'm never satisfied until I reread it and can say, "Damn! Now that's a good letter." Ha. Until I can, I just keep revising it.

Yep.

I heard from several of my favorite former medical students this week. One is named Zwade and he is now an anesthesiology trainee up at one of the Harvard hospitals. He sent me a text that told me he was working hard and remembering all of the things I told him in our final meeting. That day we sat and talked about his future and what it means to bring your 'A' game. We talked about leading and role modeling and owning the space around you. I told him I was proud of him and then I laughed and said, "You'd better not embarrass me." But he knew that I really meant that I just wanted him to always keep striving.

"You make me so, so proud," I texted.

"Your high expectations makes me try harder," he replied.

Sigh.

I also heard from Tony C-Q who is in his second year of otolaryngology residency in Michigan. He called me up on his way home and told me all about the things he was learning and doing. He then told me, "I sat with a patient and their family the other day and the patient was dying. My attending came to the bedside with me and we were really there for that family. It made me think of you. I felt like a real doctor."

And that made me cry because otolaryngology is not only super-competitive but super-high-techy and "sexy." It seems to me that the talking-to-people parts isn't what enamors most students with that field so I loved it that he recognized the importance of the humanistic parts. The sitting-with-a-patient-and-their-family parts.

"That's so good, Tony," I said. And I emphasized that word good because it deserved some emphasis.

"It was good, Dr. M. It really, really was."

Then we just held the phone in silence because it was warranted.

I wrote letters for Tony and Zwade when they were applying for residencies. I still remember hugging them tight on Match Day and destroying my mascara from weeping. Hearing from them this week came at a perfect time; it pushed me to put more heart into this new round of letters but also into my current learners.

Because this is the result.

They showed me that someone is listening and getting it. They are.

Yeah.

And lastly? Something completely unrelated.

This is what happens when your child gets a hold of your "photobooth" button on the MacBook while you're talking on the phone to a girlfriend.

I loved getting the surprise of these images in my library!

Anyways.

I looked at Isaiah this morning after awakening him. And you know? For some reason felt so much love in that moment that I thought my heart would explode.

"Good morning, my sweet Kofi," I whispered. "Aaaah. I love you so, so, so much, son." I looked him in his eyes and told him that. I wanted him to start his day knowing how I was feeling and believing that he is cherished. Because he is. And then I said, "You know? I love your eyes. They are such beautiful eyes."

They really are.

He looked at me all sleepy and then spoke words so simple yet moving. "That's because they're looking at my mom."

Gasp.

I am loving that kid exponentially today. Even more exponentially than my normal exponentially. I don't know. Maybe it's because today is Friday. I call him "Kofi" because he was "born on a Friday" and something about Fridays with Isaiah always feel special. Kofi. That's a Ghanaian name that I always loved. And whenever I call him Kofi, he seems to love it, too.

That's all I have for now. Random, I know. But such is life.

More to come soon, okay?

***
Happy Friday. From me and my Kofi.

Try not to dry heave off of the cheesiness of this song playing on my mental iPod. . . .

Cause and effect.

Isaiah happily consumes his vegetables. Mmm hmmm.

Is it bad that I convinced my child to eat carrots by showing him my thick glasses? You know, the ones that he told me are "a little bit not that cool?"

"Dude. If you don't eat your carrots you'll need thick glasses. Like these."

"Yikesy."

Oh yeah and did you get the other memo? Salads and other green vegetables makes you run faster. Like waaaay faster. The darker the green the faster it makes you run. For reals.

Y'all didn't know that?

*insert eyeroll here*

Don't hate the playa. Hate the game.

***
Happy Wednesday.

Love is not hypothetical.

Today.

A fifth grader is somewhere wishing she'd had a chance to know her dad. Wondering whether or not Dad would have allowed her to have an iPhone or to stay up past 9:30 p.m. on a weeknight. What might he have said about just a little bit of slightly tinted lip balm--okay, okay gloss--and going to see a PG-13 movie with a big group of girls but, okay, with a few boys, too?

A mother is thumbing through old photo albums and feeling that all too familiar strangling sensation in her chest. Why did she have to take that earlier flight? It was that mother's suggestion that she take it and they both agreed that getting back and taking care of the things she needed to take care of would be a good idea. So Mom dropped her off and the hug around her neck was quick because they were running late. She boarded the flight before the one she was scheduled for as a stand by and felt elated when they let her on. And that was the last time her mother heard from her.

A man has been unable to sleep for the last few days. The nightmares have returned as they always do this time of year. He has remarried and even has two more children but even as life has gone on the pain of that day still lingers like a sore that won't fully heal. Both of them were on that plane. A quick "turn-and-burn" visit to see her sister before the boy turned two. "He can still ride on my lap until he's two," she'd explained, "so we have to take advantage." It made sense to him.

So off they went. That little son was right at that age where every single thing at every single moment of every single day warrants a question. Like "What is this, Daddy? What is that, Mama? Where you going, Daddy? Why is that, Mama?" His wife always answered every single question with the patience of Job himself. Calm, cool, and without the least bit of irritation. And this just made that boy even more inquisitive. He loved that about them both.

Despite that, the nightmares always involve questions. He hears his son asking and asking and his wife's voice answering and answering in a wobbly and terrified whisper. The questions escalate and then, at some point, Mama has no answers. The last thing he sees is fear in their eyes and despite all of the mayhem there's a deafening silence.

Then he wakes up. He asks himself for the umpteenth time, "Did this really happen?"

A few seconds later his heart sinks. That deafening silence returns. It really did.

A college kid is reflecting on the first time he joined his father at The Pentagon. He was only six or seven then but he still remembers the convoluted and layered process of getting through the National security. No cameras. No cell phones. They even made Mom open her pocketbook while they dug around inside. But finally, when they got into The Pentagon, there was Dad in his "BDUs" or battle dress uniform, the term he always used to refer to what civilians all called "fatigues." And Dad picked him right up and held him even though he was in first grade and that safe feeling of being in those strong arms was one he will never forget. There were a few more times after that he got to go to see his father at the workplace but something about that very first time always stood out.

He still has the faded Crayola marker picture he drew after going there. The building with its carefully drawn five sides. "Because 'penta' means five," his dad had told him.

Penta means five.

He walked out of his dorm room this morning and saw the mirage that appears before him on the hard days. A man. In BDUs. Standing with shoulders squared and jaw strong waiting for him at the end of the sidewalk. Body stiff and at the attention ingrained into career military types.

"Dad?"

He takes a step. Then one more. The mirage doesn't fade. Those steps erupt into the jagged, arm-waving run of a first grader; his heart pounds and he anticipates that feeling and those arms safely embracing him. His imagination goes wildly into feeling those manly kisses planted repeatedly on top of shiny, sun-bleached curls and, like always, that soldier stance melting into a daddy one instead.

Aaaaah. At ease.

It isn't real, though. And he knows in the darkest place in his heart that it isn't. Across the quad he sees a flag at half mast. Faces of those who know or think they know his story are somber. Someone has tied a yellow ribbon around an old oak tree.

This happened. It did.


Sometimes the hand-holding on days like September 11 feels so. . . . hypothetical to me. I didn't personally lose a loved one in that horrific attack. I was also not physically in the places that were coated both in ashen reminders and weeping family members carrying tattered Xerox copies. In fact, these scenes described were all imagined by me. All of them. But today I know that, for somebody somewhere, they are 100% real.

100%.

So seeing it this way makes it less hypothetical. I imagined five people whose lives were lost that day. Five hearts no longer beating and the people that were left behind to love and miss them. Conjuring up mental snapshots of the real lives of real people who are muddling through the emotional rubble. The piles that remained long after the sidewalks were swept and the monuments were erected. Yes. There are still ashes. There is still pain. There are still what-ifs and what-abouts. There is still a void and there is still longing. And anyone who loves someone or who has ever loved someone can get their mind around that. Because love isn't hypothetical.

At least, I don't think it is.

***
Today is Tuesday, September 11. And we remember.

Now playing on my mental iPod. . . . 

Empathy.

The news wasn't good. The breast cancer that she thought was gone was now confirmed to be the reason for her hip hurting. First one test, then another. Eventually someone came in with the information that she'd so greatly feared. But at least now she knew.

Her fear was compounded by the fact that she knew cancer all too well. She'd seen it up close and personal as one of her parents fought it to the bitter end and, as if that weren't enough, a sibling as well. She was not naive about it or in any kind of denial about what this all meant. No, she was not. 

But she was human.

This man walked into her hospital room and loosely greeted those around her. Some family and friends had come to be with her there and this man who entered did not fall into either of those categories. He was one of her doctors and although with many diseases and hospitalizations doctors can sometimes become like family, this man did not seem interested in that at all. 

His voice was tight and disconnected. Not once was she asked how she felt today or even if she preferred to have those visitors step out of the room. Matter of fact--this was his way. 

"Sorry about the bad news," he said with forced empathy, "but, you know, we don't like it but these things happen." 

No, sir. We don't like it. And we don't like you.

He skipped right onto the business part and threw an obligatory offer to answer any questions. She had none. And so he left the room but a bitter aftertaste remained.

"I hate that man," she told one of those friends as soon as he walked out. And she was not the "hating" type. 

No, she was not.

Sometimes I used to talk to her about medical things. She was a family friend so I wasn't involved with her care but since I'm a doctor I would help to answer the things that I could. The last time we talked though it wasn't medical at all. Not at all.

"How are you feeling?" I asked.

"I'm hanging in," she said.

"I'm sorry about all of this. I really am."

"Me, too."

"I've been praying about peace. You know. Peace of mind. And that you aren't in pain."

"Thank you so much, Kimberly," she responded. And she meant that. I know because she was a woman of strong and unwavering faith. "Keep praying for me, okay?"

"I will."

And that was our last conversation. She made her celestial transition on Friday--the day I was born. 

Last week we talked about touch. Some welcome it, some aren't so keen on it. But here is what I know for sure--we all want genuine empathy and we all want support. I am so, so sorry that she didn't get either that day from her own doctor. He didn't have to hug her or touch her hand or any such thing.

But he could have done something.

***

Happy Monday. And may your soul rest in peace, Denise. The peace everyone deserves.