The Cumulative Effect: Reflections from a Sunday at Grady and Beyond

"There's only now
There's only here
Give in to love
Or live in fear
No other path
No other way
No day but today."


"No Day but Today" from the Broadway show RENT

Today I woke up at what my mom calls the "crickety-crack of dawn." I tip-toed around our room bumping into things while trying to get myself ready in the dark. Ah hah! Grabbed my iPhone and used the "Flashlight" app to see my hand in front of my face. Oww! Stubbed my toe. Why didn't you just set everything out last night? Knew the answer to that one--Too much like right.


My mom had the children at her house (and let them sleep over!) the night before, so this particular morning, Thing 1 and Thing 2 didn't have to be factored into the a.m. chaos. Took pause for a moment. . . .thought about how fortunate I am to have my mom a.) in my life, b.)in my childrens' lives, and c.) in Atlanta AND willing/able to spend extensive time with my two rambunctious pre-school boys. Love her.

Finally made it out of the house with matching socks and shoes, jumped into the car and headed to "The Gradys." Even managed to pack a change of clothes since I was planning on doing the Atlanta AIDS Walk after seeing my patients. Whew!

Smiled when I thought about the big kiss I planted on Harry before running out. Knew that he had a fun day ahead--The Falcons playing Chicago at the dome and major tailgating beforehand. One of his best friends, Derrick, had flown in from Chicago, which would guarantee some serious trashtalking. I love the idea of him doing something he really, really enjoys. And he really, really enjoys football. Especially when he gets to hoop, holler, shout, and point at the game in person. "It's an experience, babe," he has said. Eehhhhh. I'm not too big on watching football (other than the Superbowl with the cool commercials and all) --but watching Harry watch football? Now that's an experience.

Grabbed an excellent parking space on the ground level of the parking garage without even having to sneak into the MD/IN OUT spots. (By the way, I think somebody in Grady security read my blog because they now have an orange cone in front of the MD/IN OUT spaces now, but I digress. . . .) The point is, I reached the ward with time to spare . . . . .which meant more time for connecting with my patients and my team.

One patient told me he liked the way I shook his hand and always looked him in his eye. He said that most of the time, people didn't make eye contact with him and shook his hand wearing gloves. He asked me if having AIDS meant that we were supposed to shake his hand with gloves. I told him no. Promised to try hard to look everyone in the eye and to be careful to only greet people in gloves if it was 100% necessary.

Another patient said that I was the third person to come in his room and wake him up that morning. "Your student doctor was here first, then your intern or whatever she is, and now you," he said. But he didn't look mad.

"I'm sorry, sir," I said quietly, "but you know I have to see you for myself. Maybe it would be better if we all came at once?"

He smiled at me warmly. I liked the way the morning sun bathed his gaunt face in light. "To be honest with you, I don't mind so much. The student is real nice, and treats me good. He even gave me this so I wouldn't be bored." The patient held up a "WordFind" paperback book that apparently had been bought for him in the gift shop. "The intern, she's always sweet to me, and look like she really care about me. When you sick all the time, it helps when somebody is just nice for no reason, you know?" Nice for no reason. That's what I'm talking about.

I nodded while being sure to look him in the eye. I was forced to wear gloves in this room, because due to his current infection, he was on something we call "enhanced contact isolation," which requires gloves and special gowns. Thought about the fact that he, too, was living with AIDS, and really hoped he didn't think the gloves were because I didn't want to touch his hand. I softened my eyes to try to make up for the latex that stood between the human contact. "I'm glad you can feel how much people on our team care," I said. "That's really important to us."

"Yeah, everybody is nice," he continued,"and you always nice to me, too. So by the time I add it all up together, I guess it's good that y'all all come in here one at a time. It's like a whole bunch of nice visitors coming to see about you." By the time you add it all together his glass is half full. Hmmm. Made a note of that, too.

Met up with my team and rounded with them on our new admissions. Remembered the eye contact and skin-to-skin handshakes, had some great teachable moments, and kept the glass half full as much as I could. Realized that the medical students on my ward team were growing up before my eyes this month, and took a few seconds to take that in. Cool. Finished up just after noon, and sprinted out of the hospital to our office building across the street.

Jumped into my office like Clark Kent, peeling off my white coat and quickly changing into sneakers and a sweatshirt. 12:35 p.m. 25 minutes to get over to Piedmont Park to join my medical student advisees for the 2009 AIDS Walk. Felt glad that I had that ground floor parking space when I headed out. Sweet.

Took in the sights along the way. . . .a young woman exaggeratedly strutting down the Piedmont Avenue. . .damn. She broke my heart a little bit. . . .she was a little too scantily clad, a little too interested in grabbing the attention of the cars passing by, and had such a desperation about her. Saw a family pushing a baby in a stroller on this unusually cold October day. . . wondered if they had no choice but to have that infant out in 48 degree weather. . . .then I reached a stop light and glanced over to my left.. . . .a preteen girl was sitting in the passenger seat of her Mom's car beside mine. She offered me the most genuine smile. Nice for no reason. Decided I would focus on that for now instead of my street-walking little sister or the little baby out on a too cold day. Those good vibes must've worked--managed to get an unbelievable street parking space less than a block from Piedmont Park on 12th avenue. Yay.

Once I walked inside of the park, a quick wave of exhaustion came over me, reminding me that I'd already been up for several hours. Got a second wind when I saw all of the people. Hope was in the air, and lives were being celebrated. So inspiring. Saw five of my 15 student advisees walking down the grassy knoll, and we all charged into the AIDS Walk crowd together. The park was blanketed with people. . . .some laughing, some crying and hugging. The energy was rich and really good.

At one point, I heard a woman singing on the podium. . . . . .decided to stop and take it all in. The people affected by HIV and AIDS. The sons, the daughters, the brothers, the sisters, the husbands, the wives, the partners, the friends. And my patients. The thousands of cherished loved ones lovingly remembered on the AIDS Memorial Quilt. The reason we were there. Her voice rose over the crowd slowly and sweetly. . . . .

"There's only us
There's only this
Forget regret--
Or life is yours to miss.
No other road
No other way
No day but today."

Looked at one of my students, who, before I could, said, "Wow. I love that song." Sigh. Me, too.

Several Emory medical students were out there, many of whom were not my advisees. It was great to see them all there along with a few of my other friends and colleagues. But, like the mom I am, I was hoping that all of my "kids" would show up. Kept doing head counts until eventually the result was: Ant, Tony, Marla, Mara, Doug, Mark, Adam, Dapo, Doris, Jin, Hreem, Dan, Vishes, Jenna, Alanna. Recounted just to be sure. Wow. All fifteen of my student advisees were physically there for the walk. All of them. On a Sunday no less. (Okay, you may not realize it, but getting fifteen designated medical students to be in the same place at the same time for anything other than an exam or a party is near impossible.) But they were there. Some of them even had their significant others visiting for the weekend. . . .but they came anyway, sweethearts in tow.

"I'll be really disappointed if you don't come."

That's what I told them the first year when there were only seven of them. The stakes were higher with more students this year, but I stuck to a similar appeal. For some reason, it was really, really important to me to have all of them there. And they came through. All of them. With bells on. They prioritized this over something else. I can't explain to you how proud I felt at that moment.



(Student Doctor Chin-Quee shows a little team spirit . . . we even raised enough

money to get a fancy sign!.)

***

So today, I am reflecting on the cumulative effect of things . . . . .a decided effort to focus on what is collectively good. . . . . .

Like the cumulative effect of Harry being so great to me all the time is me wanting him to be happy. I've stockpiled all the small gestures and thoughtful deeds that he does every single day to make my life great. And at this very moment, he is in the Georgia Dome--likely ridiculously happy-- and probably without any trace of a voice.

Like my mom always being so gracious and involved in our lives as well as our kids' lives. It affords us the opportunity to do things that a lot of other couples can't. Those date nights, long weekends, and adult only vacations-- that she makes possible for us. Yeah. It really adds up . . . . to more satisfaction in my marriage, which means a better life for Isaiah and Zachary. Thanks, Mom.

Like gloveless handshakes, eye contact, smiles from young passengers in cars . . . it all builds into overall positivity. And yes, having all fifteen of my student advisees amongst the throngs of AIDS Walk participants on a cloudless Sunday was different than having even fourteen of them there. Something about the cumulative effect of each individual making the decision to be there was indescribable.

A day that literally started in the dark emerged into something so bright. Excellent parking space karma, students buying "WordFind" books for isolated patients, and thoughts about wonderful family. Pivotal discussions with two patients who just happened to be living with AIDS, and both of whom my students and I ultimately honored today. Kind of like a giant handshake with no gloves.

The take home point? Small things put together become big things. . . . .even if it doesn't always seem like it. Being a little unkind or a little inconsiderate snowballs. . .just as kissing your children and telling them they're wonderful makes them eventually believe it.

Be nice for no reason. Take a moment to reflect on the little things. . . . . .sometimes that's the very best way to realize just how big your life can be. :)
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"The Rain Choir" -- one of the coolest examples of how dramatic the cumulative effect of several small, everyday things can be. Try watching it with your eyes closed. . . .amazing!