Reflections from the day before the first day of Black History Month: Young, Gifted and Black

My sons: young, gifted and black

"Play" - Jacob Lawrence (1970 - 2000)

To be young, gifted, and black
Oh what a lovely precious dream
To be young, gifted, and black
Open your heart to what I mean
Cause you know
In the whole wide world
There's a million, a million boys and girls
Who are young, gifted, and black...
and thats sho'nuff where its at. . . .

"Young, Gifted and Black" by Donny Hathaway (1945 -1979)

______________________________________________________________
Thursday, January 27, 2010

I slid into our weekly Division lunch meeting a few minutes late after finally breaking away from the residents' clinic in the Grady Primary Care Center. I was still shaking off the arctic blast that had hit me when I'd crossed the street from the hospital into our faculty office building where the meeting was held. Every Thursday, this is the place where all members of our Grady General Medicine faculty come together. . . . .sometimes just to discuss business, but most times to get an update on what a colleague is doing or to hear an expert share some new development that will affect us Grady doctors. It's a great place to learn, but also a great place for building an esprit de corps amongst our faculty.

This week the speaker was, much to my delight, my friend, David M. Yay! I settled down into my chair after grabbing a plate from the catered lunch and shot him a wink. David and I joined the Grady faculty the same year, and became fast friends. Upon our first meeting, we laughed out loud for nearly an hour. Both black Americans (unapologetically so) and both pretty darn animated, David and I are kindred spirits in every sense of the word. He is, hands down, one of my favorite people. Our friendship is respectful and meaningful, and because of this our professional relationship has evolved into this reciprocal cheering section. We are constantly pumping each other up for even the smallest accomplishments, and --oh my gosh!--don't let one of us have a big achievement. We miss no opportunity to effusively describe one another to any resident, medical student, acquaintance or even rock that will listen--but most of all, we make every effort to embarrass each other every chance we get, kind of like a proud grandmama does.

Case in point:

David: "I'm just trying to be like you when I grow up! I saw your publication in Annals! Mama, you better DO it!"

Me, quick on the response: "I'm saying, David! All I want to know is which one of us was interviewed by Peter Jennings on World News Tonight before he passed away? I mean seriously, David? Peter Jennings? That's all I'm saying. "

David: "But I need to know, who got two big ol' teaching awards in the same year all while wearing 3 inch stilettos and carrying a Gucci bag? Oh, and while handling her business as a wife and a mama of two little bitty kids! This is what I'm saying!"

Me: "But work with me, D! Those were local awards, and I appreciate the shout out, I do. But help a sista out--weren't you the dude on the President's Advisory Council? No, like the President of the United States, not Emory? The President, David? Seriously? I mean come on, dude. I'm just saying -- what do you do, shoot him a text message when you have something to tell him?"

Eventually we erupt into a hearty laughter, hug, and leave feeling encouraged. It's good to have my kindred spirit rooting for me, and it's great to be able to return the favor. So there I sat, pom poms ready. I was glad that he would be teaching this day.

He stood boldly at the podium, discussing with the division slide by slide his exciting research project. "I'm exploring the psychosocial and mental health components that lead black men to behaviors that may put them at risk for HIV. So much focus is in the U.S. is placed on brothers who identify as homosexual; it makes no sense that we're ignoring this huge population of heterosexual brothers," David said in his melodic voice. I dug the way he was confident enough to say "brothers" in front of our division. It was so David of him.

After marching us through his plans for his study (funded by the huge R01 NIH grant he just won), he was met with warm applause and accolades from members of our group. His eloquent answers to their questions rolled off of his tongue like raindrops dancing from a rooftop; everyone sat at rapt attention. You better do it, Dave! I felt proud as I watched him. . . . dynamic. . young. . .gifted. . .black. I internally waved my pom poms.

"He's so articulate," some person might say, or "My, how well-spoken he is!" another might add-- not realizing how offensive that can be to the countless numbers of well-educated men like David who receive such a compliment.  

(Cultural Competency Sidebar: Most folks who graduate from Princeton like David M.--or from anywhere for that matter-- usually have a pretty good mastery of the English language, regardless of race. I'm just saying. . . . . for future reference to anyone who might inadvertently say such a thing to or about a black man.)

David M., black history in the making

dope (adj.): cool, nice, awesome (courtesy of urban dictionary)

In defense of the person who does remark on his speaking ability, it is definitely fair to say this: David M. is an amazing public speaker and his presence is rather remarkable. Here is this young Haitian-American man who has dedicated his entire career to researching factors contributing to the HIV epidemic in black men (a pretty courageously narrow area of focus)--and not only that--he's an authentic guy in every way. Dave is transparent about his preference for men as intimate partners but is equally transparent about his refusal to allow himself or patients like him to be placed in boxes of any kind. He's what my friend Tracey H. would call "dope." As I watched him teaching and answering questions, I found myself wondering, What makes a young man so okay with himself and so convinced that his voice is worth listening to? What makes him so. . . well. . ."dope?" I stuck a post-it note on the bulletin board in my head reminding myself to explore that with David at some point. As a mother of sons, I'm always interested in what makes a manchild feel whole when he grows up.

The following day, David and I walked down the street to the Sweet Auburn Market for a quick lunch, and I knew I'd get my chance to pick his brain. Amidst the chaotic lunch crowd made up of mostly Grady employees and patients, I launched into my exploration of what made my friend tick. "Dude. . . .how did you get here? I mean, like this? How did you become so okay with you, you know? It's really something to see, David. You're so comfortable in your skin. It's like. . .what every parent ultimately wants for their child. . .to be confident, fulfilled, and fearless." 

In other words, how'd you get so dope?


He chuckled at the question, and started with his thoughtful answer. He talked about several things--his parents, life experiences, and role models. Mostly general stuff. I guess it all made sense. I suppose I was waiting for some pivotal experience to be pulled out of his pocket and slammed down on the Formica lunch table in front of us. Instead, it was nice, but a lot less dramatic than I'd expected. I wanted to know who the linchpin was or what thing was the piece de resistance that made him throw his shoulders back and stand just a little bit taller.

"A lot of things,"David said while breaking off a piece of salmon croquet. For now, that would have to do. The conversation then went to our usual topics. . . . friends, work, home, news, family, patients. We finally found ourselves talking about a recent experience David had on the wards.

"There was this young brother I was caring for in my clinic that had been having diarrhea for several weeks. He had been seen in three different emergency departments and was even admitted once. He called me and said,'I just don't feel right. Everywhere I go, they keep saying nothing is wrong with me.' Wait, did I already tell you this?" I shook my head 'no'. It wasn't unusual for us to accidentally retell stories to one another. Depending on the time and the length of the story, sometimes it was worthwhile to just hear it again. But this was not a story I'd heard. I sat there quietly nudging him to go on. "He has really low T-cells, so I mean, he really could have had something going on, you know? Since he's my patient at the Ponce Clinic (Grady's outpatient center devoted to care of patients with HIV/AIDS) I made an executive decision to directly admit him to my team. When we ran through his labs, it turns out we found a positive stool study--totally explaining why he felt so bad. Nobody had believed his symptoms. He was so relieved to find out there was an explanation."

"Nobody but you," I replied. "Wow. It's a good thing he had you as his doctor."

"Yeah. . . "David said softly with a distant gaze. Suddenly he grew surprisingly quiet. He shrugged his shoulders and added, "He just needed somebody to believe him. Sometimes you just need somebody to believe you . . . .and believe in you."

"Hmmm," I murmured while nodding. I narrowed my eyes and took in what he was saying.

"As time goes by, I'm starting to see that this is part of why I am in this position, you know? To believe in my patients." David cleared his throat and then took a bite of his lunch to break up what seemed to be mounting emotion. Hmmmmm.

If you understood David's panel of patients, predominantly all black males with advanced AIDS and many of whom have had male sexual partners, you'd realize how powerful that statement could be. You take a patient from an economically disadvantaged setting, blend it with being of a historically oppressed race, and complicate it with a poorly understood and often poorly accepted lifestyle--oh yeah, and if that isn't enough, you throw in AIDS, too. It's probably hard to have somebody believing in you or much else your concerns when you fall under that umbrella.

As I sat across from David in the market that afternoon, a fleeting thought of a young, Jamaican transgendered patient that I once referred to him crossed my mind. He was new to the area, had just been diagnosed with AIDS and was totally terrified. "I have the perfect doctor who will take excellent care of you," I remember saying as I referred him to David. My confidence in David seemed to allay some of his fears. That patient needed someone to believe in him, too, and that is exactly what David did.

"That's a pretty awesome statement," I responded while staring into his now glassy eyes. I wondered where all the emotion was coming from. Hmmmmm. "It sounds like you're walking in your purpose, David. Somebody must have really believed in you for you to be able to do what you do for your patients."

David clenched his jaw and swallowed hard. "My father," his voice trailed off for a minute and then came back," My father always. . . . he has just always--" he interrupted the statement with a sigh--"he has just . . . there have been times when no one believed me. . . . and. . . .he. .he did." He stopped talking for a moment and just looked straight ahead. I decided not to nudge him much further 1, because we were sitting in the Sweet Auburn Market surrounded by Grady people, and 2, the last two times I heard a brother trying to talk about how much he loved or appreciated his father, it got real, real ugly. . .and involved some breaking down and crying -- real hard. I decided to ride it out for at least a minute or two.

We sat there quietly for a few moments, both just thinking. Then came the ah hah moment. You are giving to them a piece of what your father gave you. Aaah hah. I broke the silence and said, "So that's it. That's why you're so dope." We both laughed. I smiled and thought of the picture of his Haitian father that sat lovingly on the shelf in his office. "That's why you're so okay with yourself and your voice. Now I get it."

He sighed again and offered me a wistful smile. I could tell he was still thinking about his father. "Yeah," he managed to eek out. "Yeah."

***

So today, I am reflecting on the powerful testimony our lives become when someone believes us. . . and believes in us. Belief gives us wings to fly. It gives a scared patient the courage to get the care they deserve, it gives a medical student the confidence to step boldly into that same patient's room to participate in their care, and it even gives a same gender-loving black man from upstate New York his voice. . . . . .his audacious, intrepid, fiery, and unapologetic voice. Somebody's belief turned a mirror on him and convinced him that being his authentic self was perfectly acceptable. And regardless of what anyone else thinks about the details--I think it's a good thing to be alright with yourself.

Like I told David--now, I get it. Being loved, cherished, and believed helps us to get as close as we can to being whole. But most of all, it helps us to believe in ourselves enough to pay it forward to someone else. And at the end of the day, that's sho' nuff where it's at. :)

My daddy played this song by Donny Hathaway for me on his car stereo when I was a just little girl, and I will never, ever forget it. I still remember him shaking his head to the haunting melody with his eyes closed, and telling me to "listen to the words and to believe them." This song really symbolizes how hard my parents worked to make me believe in myself, how they fought to never let any self-hatred set in, and explains a lot about why I am the way I am. When I hear it, it transforms me into a seven-year-old again and still makes me so proud of who I am, that I cry.

Today, at the threshold of Black History Month, I am playing this song for David M. . . . . for my own sons . . . . and for all of our young, gifted and black Grady patients who may never hear these words anywhere else.

Reflections from a Clinician-educator at Grady: The Hard Question (not questions)

"Tell it like it is. . . .
Don't be afraid--
to let your conscience
be your guide. . ."


from "Tell it like it is" as sung by Aaron Neville

"Would you allow this person to participate in the care of a loved one?"

A simple enough question, right? One would think. But that question has recently changed the game for many of us clinician-educators at Grady. My friend and fellow Grady doctor, Erica B., directs our Internal Medicine clerkship and oversees the medical education in our department. Under her leadership, this question was added to the evaluation form that we use for the medical students. When I first saw it, I thought, Wait, huh? I must admit, that initial introduction to "the question" made me go back and reread my entire evaluation.

That question. That simple little question. It sneaks up behind you and taps you on the shoulder saying, "Are you sure about that?" snapping us all (or at least me--I'll speak for myself) into reality, whether we like it or not.

It's not asking the questions that often cloud our judgment. . . . like:

"Do you like this learner?" (Adore her!)

"Was this learner memorable?" (Unforgettable!)

These fourteen pesky words tacked onto the end of our forms have really put our feet to the fire. (Thanks, Erica.)

As I've said before: This job is about people and relationships. So, generally, we all make every effort to get to know the students and residents with whom we work. With very few exceptions, that has led me to like the vast majority of them. While I'm proud to admit, I'm generally not a "grade inflater," this new question has help me to put a lot of things into perspective. Like, sometimes a student or resident tries very, very hard, and is tremendously earnest in their desire to do well. It's hard to not pass someone like this. . . . . but at the end of the day, depending on their level of training, would you want this individual caring for your loved one. . . .or better yet--you?

It's no surprise that this inquiry is incredibly telling. In fact, Erica B. has even given presentations and done scholarly work surrounding all that they've learned from just asking this of the evaluators. Now we're forced to acknowledge what an awesome responsibility we've been given. Everyone is relying upon us to work closely enough with these future doctors to be able to make honest assessments of their progress. Your mom and my dad and someone else's sister is banking upon my evaluation of this person who could ultimately be the one standing over them in a life or death situation. Did you see some fleeting thing that worried you about this person in the role of lifesaver? Well?? Did you??? See? Erica B. was right. It all comes down to that question. Case in point:

Several years ago, I worked with an intern who was fun. Very fun. His comic timing was perfect, and he was extraordinarily likable. I enjoyed working with him and liked him very much. He seemed to respect me immensely, and it showed. But there was a problem. He was a rusher. Nearly everything he did in the hospital was hurried which translated into missing things. Fortunately, our system allows for checks and balances but when our service got busy, as inpatient services often do, there were definitely a few "near misses." Even though this intern was smart, and funny, and even deferential towards people like me, he only did the bare minimum. This sloppy work tendency was a problem--a major problem.

"Dat'l'do" (short for "that will do," in case you missed it.)

Being cursory when it comes to taking care of human beings is fraught with peril. I mean, who wants the doctor caring for them or their loved one to be anything other than meticulous? "Dat'l'do." That's what my dad calls anyone who does things half-way (or "half-assed" if you want to keep quoting my dad) and who doesn't take real pride in their work product or those affected by it. It's doing just enough to get by--and forget going above and beyond. "He's 'dat'l'do'," my dad would probably say after hearing about such a person (or perhaps he'd say "half-assed"--but keep in mind, those are Dad's words, not mine.)

After several oversights--"Did you realize that no one wrote an order to not let Mr. Murphy eat before his surgery this morning?"-- and many feedback sessions-- "The consequence of letting him eat is that his surgery was cancelled. It's critical that we all prioritize what needs to be done before leaving for the day." "Oh, my bad, Dr. Manning."-- I found myself staring at the computer screen, completing his electronic end-of-the-rotation evaluation. As I clicked the mouse through every objective question determining my take on his patient care or professionalism or ability to learn from mistakes, I grew more and more weary. Eeek. Was his performance satisfactory? Was it? I mean, sure, it wasn't like he was stellar in terms of completing tasks, but on this 1 - 5 scale, '3' says Dr. Manning thinks it was "satisfactory." Was I really, truly satisfied with the fact that he left three times without checking in on a sick patient or with the lab result that he forgot to check or the patient that he promised to come back to explain a plan to but never got around to it? Well? Or better yet, would I want him participating in the care of one of my loved ones?

The answer was, unfortunately, no. No. I wasn't satisfied, and, no, his work product that month wasn't satisfactory. (Erica B.'s question sure would have helped me get to this decision a lot sooner.) I remember agonizing over this evaluation. This was early in my career, and it would be my first time "failing" someone--and I felt terrible about it. Part of me was tempted to fill out the failing evaluation and just avoid him for the rest of his residency. Since I'd personally experienced and beared witness to these kinds of "sucker punches" in my own training, I knew that approach wasn't cool. He deserved to hear this face to face, and not during some annual meeting with his program director 4 months from now. I owed it to him to tell him the truth. . . . . and I owed it to my loved ones, too.

"Tell it like it is."

It isn't as easy at it might sound. Perhaps when the errors are horribly egregious, I guess someone could slam their hands down on the table and growl in exasperation, "You will NEVAH no not EVAH be a doctor!!" or, at least in this kind of over-the-top situation, Erica B.'s question wouldn't be so difficult-- "Take care of my loved one? I don't THINK so!" But the truth is, most times it isn't that straightforward. The unsatisfactory learners often cloud your judgement with likability or their own complicated "situations." To quote Dad again, this job "ain't nothin' to play with."

I sat down with him in a quiet room. No distractions, eye level, face to face (as any respectable clinician-educator meeting with a learner would.) "Let me give you some feedback," I started out. My division director, Dr. Branch, taught us to start off all feedback with the word "feedback." It supposedly puts folks on alert that this is not just any old conversation. It says, "This is the real deal, buddy. I'm giving you the scoop on how you did." Yeah, let me give you some feedback. So far, so good.

Armed with all that Dr. Branch taught me, I went into as many specifics as I could. I explained my concerns with the multiple things that he overlooked, missed, and omitted. I jogged his memory about the times when the resident or I had discussed these issues with him and offered suggestions on how to get more organized, that this had not led to a satisfactory improvement. "I'm afraid I have no choice but to give you a "marginal" evaluation. I just can't say that you are performing at a satisfactory level in these areas, or overall on this month for your level of training." There. I did it.

I held my breath and waited for him to scream in protest. Instead, he dropped his head and sighed. "I'm sorry for letting you down, Dr. M. I really am. I just. . . I just have trouble staying organized sometimes. I look up and the whole day is gone and I feel like I'm only through half of my list. Then the resident does everything I didn't get to, so. . . . .I guess I got used to it." He was tearful, and from his quivering lower lip, surely he was being 100% genuine. You suck, Manning. How can you fail him when he's sorry for letting YOU down? Arrrgghhh! No. . .do not wimp out. Do not!

I shifted nervously in my chair. Be helpful. . . not mean. Be honest. . . . not fake. We talked for nearly an hour about why he felt so distracted, and some more specific ways to help him refocus and get more efficient. He listened carefully, and never once challenged the things I said. It surprised me to see how receptive he was to my words. He was far more comfortable than I was with the whole exchange. I learned that he wasn't just being lazy, and that this was a problem with many layers. An intern with some serious organizational deficiencies had been paired with co-dependent micromanager resident--a recipe for either many near-disasters or a sho' nuff disaster the minute things get busy (as they often do.)

"Look," I responded softly, "this isn't about me--so don't worry about letting me down. The hardest part of this is that I really like you, and truthfully, I think you're capable of more. For that reason it's unfair to you to let you go forward this way, you know?" He sniffled and nodded without looking up. Oh my gosh. Is he crying? Wow, you suck, Manning. Congratulations on officially traumatizing a brand new doctor. Bril-liant.

"Yeah. . . . ." he responded rubbing his stubby hand through his hair, "I know." He let out an exaggerated sigh and rubbed his eyes with the palms of his hands. "Listen, Dr. Manning. . ." I raised my eyebrows in attention. "Uhhh. . .thanks. . . .I mean. . .I appreciate you caring enough to tell me all this. Really. I know it wasn't easy."

Whew! He had no idea how relieved I was that he didn't flip the desk over like that lady on The Real Housewives of New Jersey (oh, admit it, you've watched it!) In addition to this being the first time I had ever given an unsatisfactory overall mark to someone on my team, it was also my first time just giving not positive (see how afraid we are of the word "negative?") feedback to someone "straight with no chaser." I could hear Aaron Neville's shrill voice in my ear--"Tell it like it is. . . ." I think his coaching helped a lot that day. You see, up until then, I'd always used this technique that folks in medical education call the "sandwich" method. You sandwich a not-so-flattering remark with two flattering remarks. Most learners see it coming a mile away:

"You have amazing ironing skills! I've never seen such a perfectly starched lab coat!" (the top slice of bread)

"Oh, you are pretty much an assassin." (the bologna or "baloney" )

"Do you use Pantene on your hair? It has amazing body and shine!" (the other slice of bread)

(Now that I think of it, seems like the "baloney" is usually on the outside of this sandwich, but that's just my opinion.)

Anyways, I once heard an expert say that the goal of feedback is to 1.) teach the learner something, and to 2.) bring out the best in him or her. If indeed that's the case, I can't see how dancing around the issue helps. Deep down, I knew that this was true for this situation. I really wanted to teach him something and I wanted this learner to be better. I really did.

I looked across the table at him and smiled. "You know what? For me, a lot of things come down to the 'my mama' or 'my daddy' rule. When I'm faced with certain decisions in the hospital, I ask myself 'What would I want for my mama or my daddy?' It puts me back on track, you know? Makes me look up something I'm unsure of, call help when I need it, or turn around and go back to see someone on the ward when I'm already in the parking garage." He didn't say anything, but he nodded slowly. I think he got the point.

My mama and my daddy

"Would you allow this person to participate in the care of a loved one?"

This is what it all comes down to. Not about me liking you, or your lovely penmanship. Whether I like it or not, when I give the green light to a resident or a student that gives me real concern, I'm letting down more than that learner. I guess the reason I'm blogging about this today is that I'm just realizing more and more how much is at stake. And listen--I'm not forgetting my other responsibilities in this crazy medical upbringing either. I'll make every effort to get my students and residents to a place where I can say "yes" to the above question without batting a lash. I'll spend that time doing extra sessions with the students or helping a resident come up with a plan in clinic or even shadowing someone to see where they can improve. But if for some reason, after giving my very best effort, that learner is not where they're supposed to be--I'm going to tell the truth about it. To, as that expert said, "bring out the best and teach," yes. But even more because my mama and my daddy (and several other folks' mamas and daddies) are counting on me to "tell it like it is" -- and shield them from anything or anyone "dat'l'do."

"Tell it like it is" as performed by Aaron Neville and the Neville Brothers
(and joined by Greg Allman and Bonnie Raitt--pretty gnarly stuff!)

Reflections from a Wednesday: False alarms and Fragility

Negmaron monument, Haiti

Zachary, safe in arms after a false alarm
_______________________________________________


For all those born beneath an angry star
Lest we forget how fragile we are

On and on the rain will fall
Like tears from the star
Like tears from the star
On and on the rain will say
How fragile we are. . . how fragile we are

-Sting "Fragile"
____________________________________________________

“Mommy! Mommy!” I heard a little voice screaming from upstairs. I looked toward the basement door, which I had left cracked before going down to deal with a load of laundry. Frantic feet were pattering above my head, and I knew it could mean only one thing—Zachary was now awake. “Mom-maaaay!!” The urgency in his voice was growing. I knew he’d made the drowsy trek into my bedroom upon opening his little eyes, and was alarmed to find I wasn’t there. I did my best to quickly shovel the damp clothes from the washer into the dryer before he completely melted down.

Harry had taken Isaiah for a haircut, and Zachary, who had fallen asleep in the car on the drive home from school, had stayed behind with me. I scooped him from his car seat, quietly laid him down on his bed, and tip-toed away; hoping this would give me a moment to do a few things, and most importantly, nothing for a few minutes. Not even twenty minutes later, he awoke, very much alarmed that there were no signs of his mom or any other life in the house.

After scurrying up from the basement, I opened the door to find Zachary standing in the hallway, visibly shaking from crying so hard. His entire face was covered with snot and tears, and the minute he saw me he almost fell down from trying to get to me.

“Here I am, bud!” I spoke softly, “Mommy was right downstairs. Here I am, baby.”
His heart was pounding hard against my chest, and every few moments he would tremble while trying to catch his breath. I carefully looked at his face and realized that this was not just a dramatic toddler moment. He was truly terrified. My 3 year old son thought, if only for 90 seconds, that his mother was gone.

“M-m-mom-meeeee-hee-heee,” he whimpered repeatedly as I continued to do my best to reassure him. Over and over, I told him not to worry.

“Mommy’s not going anywhere, baby. Mommy would never leave you, okay?” It was a false alarm, Zachary. Mommy is here.

Finally, his heart rate and anxiety level returned to normal. Before you knew it, he was comfortably entrenched in the Nickelodeon channel and his lovey (a now ratty and super scary quilted blanket)--much calmer now. Fifteen minutes later, Isaiah burst into the door, tongue blue from the lollipop his dad rewarded him with for sitting still, and with another unopened one in his hand.
“For you, Zachy!” Isaiah announced presenting the candy to his recently traumatized little brother like a bouquet of fresh flowers. Zachary squealed, stripped the wrapping off, and closed his eyes with glee upon burying the lollipop in his little mouth. “Luwwy-paah!” he giggled with nothing but a stick poking from his lips. Life was good again. It was a false alarm. Mommy and Daddy are here.

I have thought about that day several times over the last week. I sometimes imagine this nightmare where Zachary or Isaiah was crying out for me or Harry in escalating terror . . . .and we are nowhere to be found. They open and close doors, holler down hallways, and even wander out the front door, all the while shrieking, "Mom-maaaayyy! Dad-daaaaay!!!" But to no avail. Then I shudder at the thought, and feel relieved. . . . realizing that I am here and they can find me. And Daddy. Whew.

A little over a week ago, a massive earthquake hit Haiti, rattling nearly every standing structure in the capital and its surrounding provinces to bits. Over 100,000 people lost their lives, and thousands and thousands more were left with life-threatening injuries. The images are horrible; the reality of it so disturbing to put your mind around that you cover your eyes with your hands, turn the channel, but then turn back while peering between your fingers. I can't believe this is happening in the world right now, I keep gasping. I squeeze my eyes tight and pray as hard as I can. Lord, have mercy. . . . please.

Before I know it, I'm back on the news channel again. . . . . . staring. . . aghast. Oh Lord. A youngish man is sitting on a pile of rubble crying--hard. In his hand, he is tightly gripping a frayed, wallet-sized photo of a woman. He is child-like in his every action, eventually crumbling into tired sobs. In Kreyol, he expresses that his wife is buried somewhere under the ruins. And he can't find her after 5 whole days. Oh my gosh. They dig with tiny picks, often in the dark, until finally, a shrill voice can be heard faintly amidst the piles of concrete. 3 1/2 hours later, everyone pitches in to pull this man's wife out of what surely she thought was her grave. What a resilient people. I clap my hands and wipe away tears. At least one happy ending. At least one false alarm. Then the camera pans across to the street. . . .people are everywhere. . . .roaming, screaming, lost, broken. Please, Lord. . .have mercy. . .I unsquench my eyes, and that's when I see it. This fleeting image of a little boy walking alone in the corner of the camera angle. Covered with dust, looking exhausted. . . .and surely no more than four years old. His eyes were empty, and his mouth was open and crying-- but I couldn't hear his voice. He had probably screamed for his mother so many times that he'd lost his tiny voice. The sun was setting. It would soon be pitch dark all around him. Suddenly, I felt sick. This is really happening.

I pictured Zachary--frantic and afraid. . . after only 90 seconds out of my sight in broad daylight. A false alarm. Mommy is here. Thank God. That little child stepped over rocks, debris, people. . . all alone. He looked terrified. Oh, that precious little boy. . . and the hundreds of thousands of children like him. . .wishing for false alarms, scared of the dark shadows that no grown up is there to explain away. I've been getting these chilling visions of lonely armies of toddlers and school-aged children. . . . aimlessly wandering. . . crying and shaking. . . .each of them lifting rocks, craning tired necks behind trees, hysterically yelling without sound, "Maman! Papa!" but met with no reply. No Mommy or Daddy to emerge in 90 seconds, or 90 hours, or even 90 days. . . . No false alarm. Maman et papa ne sont pas ici.

Then, like many people, I start crying. . . .anxiously jumping online or texting to make some kind of donation to somebody somewhere in Haiti. . . .only to find myself peeking through fingers again a few hours later, hoping that it was all just a false alarm. But it's not. It's real. It's really happening.

Okay, I am not sure about you, but sometimes I feel like a helpless voyeur. Shouldn't I be doing something? I think I will start with the following pledge:

1. I will do something not nothing.
2. I will force myself to know and remain aware of the suffering of other human beings
3. I will pray for the survivors and their families, and for the relief workers in Haiti.
4. I will not let myself forget this is happening.
5. I will not let myself forget this is happening.
6. I will not let myself forget this is happening.
7. I will appreciate my life more every single day.
8. I will be kind.
9. I will recognize how fragile we are.

I told one of my med students, Antoinette, just the other day that I struggle with the parallels of the world. . . .how there are people sleeping under bridges across the street from Grady, and people sleeping under piles of sheetrock in Haiti, and people sleeping under 600 thread count down comforters right here in Atlanta all at the same time. How do you even reconcile that? Look, I'm not trying to get all preachy-preachy here. I mean, it's not like I was the one left out there in the very center of the darkest part of the night all alone with 200+ critical patients like another Grady doctor, Sanjay Gupta, was. But if we believe that we are all connected, which I do, then our collective gestures great and small, amount to something mighty, right? Kind of like when the little "Who" in the Dr. Seuss book "Horton Hears a Who" finally did his part, it changed everything. His one voice made all the difference. So every person counts.

"A person's a person, no matter how small." ~ Dr. Seuss

It's hard to know where to start. I wish it were as simple as the Nickelodeon channel and a lollipop. . .but this time it's not. My best guess is that it begins with knowing. . .and acknowledging. . .and, well, seeing. . . . then, doing my part, whatever that is. I'm still not even sure what "my part" is exactly. . . .but what I do know is this: The more I force myself not to turn the channel away from those motherless children, away from those Grady patients right in front of me or away from those parallel lives existing in far corners of the world or sometimes just across the examining table. . .the closer I get to finding out.

Parallels. . . .

School kids in Haiti

School kids in Atlanta

"Lest we forget how fragile we are. . . . . ."

Sting singing "Fragile"

Reflections from a Saturday: I see you (but not with the hairy eyeball)

What's better than this?

Ran across this gnarly picture of Gary Coleman aka "Arnold" giving an outstanding demonstration of the "hairy eyeball." This image made me laugh out loud today. It took me straight back to elementary school, and really made me want to find a pair of those sneaker rollerskates with the big stopper in front like "Tootie" had on Facts o' Life. At first glance I thought, Aaaaahhh! Now THAT'S a hairy eyeball! Now. . . speaking of the hairy eyeball:

I'm just sayin'. . . can a sista get even one comment on a post in 2010? Hello? (tap, tap, tap) Is this thing on?

Last three posts-- I scroll down, and. . . . crickets. I do appreciate that y'all are reading (because you are so nice to tell me that you do in person), but wish I could say I didn't always do a little "happy clap" inside when I see a lonely comment under a post (even if it's sure to be from my parents or little sister.) I'm learning that every respectable blogger generates a comment or two for their entries--but truth be told, I am not sure if I have achieved respectable blogger status just yet. I almost entered my own comments once just so I wouldn't have goose eggs under my posts, but decided that was pretty lame.

Anywho. . . . .enough of all that!

"I see you."

Harry and I saw "Avatar" last night. Gasp! Such a gorgeous movie. . . and yes, I meant to say "gorgeous." It was really like a party for your eyes, especially if you see it in 3D like we did. We didn't get to see it at an IMAX theatre, but I am feeling like that needs to get put on my "bucket list" for sure.

My favorite part of the movie? This one line, that recurs throughout the film: "I see you." The natives of the film's fictitious planet "Pandora" greet one other by saying these three words. I see you. The meaning is all encompassing. . . . .like I see you--literally, but even more, I see you. That was my favorite thing in this whole gorgeous movie, which surely I will see again (that is, if I can get a sitter before it leaves the theaters.)

I see you. At the end of the day, I think that's what I try to achieve with my patients, my colleagues, my residents and my students at Grady. I just really hope my actions say, "I see you." Literally and beyond.


I hope when you read this blog you see me--and Grady, too. And every blue (no pun intended) moon, I hope you'll take a moment to tell me so in the form of a comment.

I see you,

gradydoctor :)

Seinfeld Moment on a Wintry Day at Grady: The "Hairy Eyeball"

The Parking Garage (as represented by this toy version)

The Hairy Eyeball (as demonstrated by Isaiah)

_____________________________________________________________

I'm saying. Can I just please vent just for two minutes--okay, maybe three?


8:32 a.m. Thursday

Shoot! Shoot! Shoot! Not being late was on my New Year's resolution/revolution list for 2010, and here it is just January 14 and this is already like my 3rd time being late somewhere. Despite the interventions that my beloved Harry has tried to make, (intervention meaning: "BABE!! Why, why, why do you HAVE to be 5 minutes late everywhere you go?!") I admit it. I am perpetually 5 to 10 minutes behind nearly every 8 ball. But that is not what this post is about, so before you tsk-tsk-tsk me, let's get to what happened in the Piedmont Parking Deck at Grady this morning.

Okay. . . here's how it all went down:

Like I said, 8:32 a.m. Other than being tardy for the clinic party, the morning was going well. NPR was doing a great job of giving me the up to the minute scoop on all things important in the world, and I managed to avoid talking on my phone for an entire commute (an astounding feat, if you know me.) I pulled into the deck and waved at Johnny, the Security officer in the garage that morning. Predictably, I fished around my console for my badge.

"Need me to let you in, doc?" asked Johnny in his normal friendly tone. "I know how that badge always hides from you." It's good to be down with the parking garage personnel. I'm just sayin'.

"Naaah, not today, my friend," I laughed while touching the badge to the magnetic plate, "Today I have my act together." The yellow wooden arm flew open, and I whipped my car toward the first row of ground floor spaces, fingers crossed for some good parking space karma this morning.

"This is WABE National Public Radio. Your home for the classics and NPR News. The time is 8:34 a.m."

"Girl, your daddy would be mortified if he saw you running late like this," I said out loud to myself in the rearview. Wait. . . is that someone from the overnight shift getting ready to leave. . . getting in her car. . . .putting keys in the ignition. . . . woo hooo! Yes, the heavens have opened up on the ground level--brake lights! "Yeeeaaaaahhh Baby!" I exclaimed with a Tiger Woods fist pump. (Wait, is it cool to do the Tiger Wood fist pump still?) Either way, brake lights on the ground floor when you are running late is like the "hot light" being on at Krispy Kreme Donuts -- instant happiness. I needed some good parking karma, and it looks like I was about to get my wish.

I clicked my left turn blinker and while waiting for the car to back out, I flipped down my visor for a reflection check. Made a quick glance at the car in the coveted space confirming that it was indeed my lucky day-- exhaust and condensed air blew from the tailpipe-- this was no false alarm. Yes, girl, you scored the motherlode ground level parking space in the 8' o' clock hour. As my Long Island-native mentor, Neil W., says, "Who's better than you?" I clenched my teeth and inspected them for random food remnants in the vanity mirror. Another peep at the car in "my" space--still no reverse lights.

After pushing my sunvisor and mirror up, I notice the driver in the parking spot. Her visor is down, and she is, I'm pretty sure, picking clumps of mascara off of her lashes. Are you kidding me? I start to place my hand on the horn, but then realize that I was being a hippocrite. I did a teeth check, surely I can grant her a mascara fix. Rut roh! A line of cars is mounting behind me; I try to pretend like I don't see it in my rear view. I need this parking space.

Her visor closes but driver still not moving. Wait. . . what the. . . .what is she doing? I squint my eyes to see, and, I kid you not, it looks like she is reading a newspaper on the steering wheel. Shut up! Car train behind me is growing. . . . .what the . . . .okay, I am two seconds from blowing my horn.

"Beep! Beep!"

Someone behind me offers the "nice beep." Not the obnoxious "Oh No You Di'in't" beep where you place all your weight on the horn, but that half-hearted honk you give someone who doesn't realize the light changed. I decide it's perfectly reasonable for me to offer her the same "nice beep." My "nice beep" yields nothing.

I am now backing cars up into the yellow wooden entry bar. Johnny is standing on his tippy toes trying to determine what's holding things up. Mascara lady could care less. She is reading her newspaper and probably doing sudoku at this point. "What are you DOING!?" I growl, this time doing a more manic version of that Tiger Woods fist pump. Then, tightly gripping my steering wheel, I lean forward as far as I can. . . .and that's when it dawns on me what Mascara lady is doing:

OMG. Seriously? Seriously. She is WARMING UP HER CAR. You heard right--she's warming up her car! On the ground level, no less. Oh, and according to Kai Ryssdal the time is now 8 fricking 37 a.m! Uggghh!!

My late-ness has my judgement clouded and my impulse control dangerously teetering on nonexeistent. I am hoping she turns around so she can see me giving her the hairy eyeball. (See picture of Isaiah, above) For those who are unfamiliar, the "hairy eyeball" can be given for many reasons. It can be given to someone who has made you mad, someone who you are suspicious of, or someone who is getting on your nerves. It is admittedly quite passive-aggressive--and is particularly useful when the recipient does not realize they are getting it. I have my pal Tracey H. from residency to thank for my use of the hairy eyeball, and now most of the time, we discuss the hairy eyeball only in the context of our husbands. But today, Mascara lady deserved it.

"Loo loo looooo. . . ." I'm sure that's what she was singing in her car while ruining my morning. I really want to scream. Warming up your car? Are you serious? Who does that? Clearly this falls under that unspoken understanding that you only do one set on the machine in the gym when someone is waiting. This is my parking space, not that blue Prius that is probably also late and behind me. (See "Honorable Mentions" Post September 25, 2009.) Okay, that's it. I'm getting out. I'm going to simply walk over to her driver's side window, and kindly ask her, with my warmest smile, to move yo' damn car before I key it. Hard. Okay, no, I'm not the violent type, but I am from L.A. and I really, really need that space. It is mine. I feel I have destiny with this space.

From the corner of my eye, I see Johnny beginning to walk toward the inside of the garage to deal with whatever the "problem" is. I feel my anxiety growing. Surely I can walk over and just politely tap her frigid window and say, maybe even with a fake British accent, "Pardon me, love. . . .perhaps you could slide out of that space and warm your car up on interstate 85, my lady? Bril-liant!" I am now feeling whatever the equivalent is to road rage in the parking garage. Any exchange I have with her at this point will be downright indignant.

Johnny the security man is getting closer. Mascara lady is probably flipping me off under that sudoku in her newspaper. I want to cry when I finally cave and pull off in defeat--just two seconds before Johnny gets to my tail light.

"Aaaaaarrrrrggggghhhhhhhh!!!!!!" I holler as I roll up through the garage. . . .third floor. . . .fifth floor. . . . 7th floor. . . .I'm getting high altitude sickness. Now come the expletives which I will spare you from reading.

"This is WABE National Public Radio. Your home for the classics and NPR news. The time is now 8:41."

I'm going to cry. I mean it. According to Kai Ryssdal from NPR, I officially just went from late to late-late. Damn.

When I finally did slide into the clinic (which was well after my 8:30 hit time) I was incredibly thankful to my colleagues, Iris C. and Laura M., for not giving me the hairiest of eyeballs (which I so richly deserved.)

The Hairiest of Eyeballs

The Bright Side of Mascara Lady:

Yes, I missed out on the motherlode parking lot. And yep, in the end I parked on the ninth floor and was not just late, but late-late. Aaaahhhh, but the bright side in all of this? I scored me some exceptional blog material. . . . . and that made it all worth while. :)

Reflections from a Monday in Clinic at Grady: Fearfully and Wonderfully Made

Mount Everest

_________________________________________________________
4:25 p.m.

"Ms. Bates! Ms. Geraldine Bates! (name changed)," my voice rang out over the waiting room in the Primary Care Center. I waited a few moments for someone to begin shuffling in their seat, and collecting their coat, hat and WordFind books. No answer. "Ms. Geraldine Bates!" I spoke louder, this time craning my neck around the door to be sure those on the other side of the room could hear. Not a peep.

I've been working at Grady for nearly a decade, and if I haven't learned anything, it is this: Nothing is ever what it seems. You mean to tell me it's 4:25 p.m., and the last patient of the day is a no show? As my Auntie Deirdre always says, "Chile' please." There is no way that it would go down like that on a Monday afternoon in the Grady Primary Care Center. If it seems too good to be true--which getting out early on a Monday seems--then indeed it is.

Back in the day, I did the obligatory "name call," and even paced through the waiting area in case someone was hard-of-hearing. If nobody bit, (doing little to hide my excitement)I would make a beeline for my purse and coat, and then bolt for the nearest stairwell. A patient who doesn't answer is what we affectionately call a "dinka" -- our slang term for the person who did not keep their appointment. It took me only one or two times to learn my lesson. I'd get my mind all set on an early departure only to have my bubble burst by a nurse giving me that nauseating page (sometimes answered from the parking lot, uggghh!) that I overlooked somebody sleeping in the waiting area. "Oh yeah, and he is elderly," they always added, "and looks like he is breathing kinda hard." Damn.

Now, I know better. Geraldine Bates would not be deemed a "dinka" until I shook every shoulder of every dozed off thing in the room--animal, vegetable or mineral. I strolled through the room, looking from side to side. I stopped in front of a very obese, disheveled appearing woman leaning back in one of the vinyl arm chairs that lined the walls. The back of her head was wedged between the wall and the top of the chair, and her mouth was wide open. She was completely still, almost like a corpse. Several plastic bags, full to the brim, were scattered around her swollen feet which were bursting out of unlaced, run down sneakers. A dank odor that seemed to be some murky combination of must and urine wafted across my nose as I looked down at the chart in my hand. 43 years old. Although I couldn't place an exact age on this sleeping patient, my guess was that this was indeed my absentee.

Suddenly, she released an intrusively loud snore; more like the cross between an angry growl and someone biting the crunchiest apple ever. It cut through the air like a noxious siren, signaling danger to all around. In addition to startling me, she jolted herself awake, immediately attempting to save face by sitting up in her chair and looking industrious. Some of the other patients graciously continued to thumb through their magazines or keep their eyes glued on the television, while the less-kind raised their eyebrows, shook heads, or even audibly chuckled. The patient batted her now bloodshot eyes and gave me a bewildered stare.

I lowered my voice and asked, "Are you Ms. Geraldine Bates?"

"Yeah ma'am," she replied in a throaty, almost congested sounding voice. She leaned over to collect what appeared to be everything she owned from the floor. I placed the chart under my arm and pitched in by picking up two bags as she slowly followed me back to the examination room.

I gestured for her to enter room 51 and went to find a larger sized blood pressure cuff, knowing the ones I had would never work. The minute I reentered the room, I was struck by how rapidly her pungent body odor had permeated every corner of the small space. I made a decided effort to respect her enough to show no reaction.

"I'm sorry about how I smell," she instantly apologized. I could feel my face flushing, embarrassed that perhaps I'd been one of those less-kind people with a poorly camouflaged facial expression. "Sometimes it is hard to get to a restroom with all my stuff, and I don't always have access to a shower or nothin'."

"It's okay," I replied with a smile. I held out my hand. "I'm Dr. Manning. How're you doing today, Ms. Bates?" She sat there looking at my hand for a moment before reaching out to shake it.

"Umm, I'm, umm, okay," she responded.

"What brings you here today, ma'am?" I inquired while connecting the blood pressure cuff to the wall.

"I 'on't know," she answered initially, "Well, no. Yes, I do know. I get tired a lot." She didn't have to tell me that. Her outburst in the waiting room was nearly diagnostic of sleep apnea. I wish I'd had a few medical students with me to witness it; it would have been a teachable moment for sure.

"Yes, I saw that," I confessed. "You seemed pretty tired in the waiting area."

"And my head hurts sometimes, too, especially in the morning 'cause I feel like I haven't rested. I feel like I falls asleep all the time but don't never get no rest. It's crazy."

"Has it been like this for a while?"

"Yeah ma'am. I be tired all the time. Then I stay in the shelter, and they make you get up early and get out. I be so tired, doctor. I be outta wind and short at the breath." She shook her head for emphasis. "It's hard, doctor." It sounded hard.

"I bet," I said while looking at her closely, "Have you ever seen a doctor for this. . . I mean the tired feeling?" I took a mental picture. Her eyes were defeated and tired appearing. The dark skin of her neck was even darker in the creases; accentuated by a velvety pigmentation. Each of her fingernails had a perfect strip of black dirt deeply embedded below the nailbed. She tucked them under her jacket when she caught my eyes resting on them.

"One time they said I had the sleep apnee," she spoke, "and they gave me a machine. I was 'posed to put it on when I sleep, but then one time I fell asleep in the Marta station and somebody stole it. But that was a long time ago."

"Dang," I caught myself saying out loud. I went through the rest of her current and past medical history, and then proceeded to examine her. Blood pressure was elevated, otherwise the exam wasn't that remarkable with the exception of her weight. I helped her down from the exam table as we prepared to discuss the assessment and plan for her.

Assessment:

1. Severe obesity. Body Mass Index 51.6

2. Probable Obstructive Sleep Apnea secondary to Obesity Hypoventilation Syndrome

3. Stage 2 Hypertension, uncontrolled, likely secondary to #1 and #2

4. Lower extremity swelling/edema, likely secondary to #2

5. Unstable housing/homelessness

I sat there staring at the chart in front of me. This is so whack, man. What am I supposed to do? I mean really do? Ms. Geraldine, I want to help you, but will you fire me if I admit that I don't know how to help you? Will you scream at me if I throw my hands up and say I wasted your time today? I felt like my arms were being pinned at my sides and I couldn't move. What kind of "plan" exactly could I offer? I mean, sure, I can write a whole bunch of things, but I mean, a real, bonified, helpful plan? I wasn't feeling that positive.

Plan:

1. Discuss weight loss strategies. Refer to nutrition. For what? She doesn't have any groceries. Just say "no" when Meals on Wheels gives you a fat-laden free meal or when a nice stranger offers to buy you a two piece meal at Popeye's. Prescription for exercise discussed. Yeah. Carry everything you own on your back for ten miles every day with swollen legs. I know, Ms. Geraldine. My exercise prescription is not so realistic for you.

2. Refer for sleep study to confirm diagnosis of Obstructive Sleep Apnea. Yes. Schedule her for a sleep study with a co-pay she can't afford. Attempt to get records from prior sleep study, if available. Then I can get her a CPAP or BiPAP machine so somebody can steal it. Great.

3. Start Hydrochlorothiazide 25 mg, start Amlodipine 5 mg. Wait, Amlodipine could make her legs swell and her legs are are already swollen. Change that Amlodipine. Atenolol 25 mg. Anticipate improvement in B.P. with management of #1 and #2.

4. Anticipate improvement of swelling/edema with management of #1 and #2. Check echocardiogram to evaluate heart function. Compression stockings. I know they will make you miserably uncomfortable, Ms. Geraldine, and will be very difficult to put on, but yeah, lets do that, too.

5. Refer to social services. Our social worker is awesome, but she is human. Please don't fire me, Ms. Geraldine.

Let's add this to the plan:

6. Get you a loving home and a rolodex full of family support. Remove any self-loathing that you have and replace it with extraordinary self esteem. Get you money and the knowledge of how to manage it. Place you somewhere safe with a nice fridge and access to fresh foods and fresh air. Inspire you to find a career you love and to leap from bed every day to exercise and to do fulfilling things that change the world.

I half-heartedly reviewed my plan with Ms. Bates who seemed surprisingly okay with it. I tried my best to smile and look positive while answering her questions. I placed my chin in my palm and sighed, finishing up her prescription. I wished there was someone who could help me achieve #6 on my plan.

"You okay, doctor?" she asked me, turning the tables. She meant it. She really wanted to know if I was okay.

"Not really," I answered with an exaggerated sigh. Did I just really say that? "Ms. Geraldine. . . . .where is your family? Your peoples? "

She picked at her gritty nails. "They in Athens and here. But I don't have nobody." Nobody? You don't have NOBODY?

"Why not? What happened?" I quickly replied, again smacking myself on the back of the head for being so forward. "I mean. . . .you're young. . . . like. . . how did this happen?"

"What? Me being homeless or me being. . . ." she cast her eyes downward toward her body, ". . .being like this?" I hoped it was a rhetorical question. Shoot! I offended her! Wait, did I? She sighed and shook her head slowly. "I don't even know, doctor. I mean. . . .I guess nobody paid attention to me, you know? And when they did pay attention, it wasn't the good kind of attention. Mama passed on when I was in the 9th, so I didn't finish. Don't have no relationship with my daddy. Then when I got big like this, it's like I went away. Nobody want nothing to do with me. Stankin' all the time, can't do nothing. I don't blame 'em."

My arms went from pinned to tightly restrained with handcuffs behind my back. I felt a small wave of nausea along with an almost overwhelming urge to run out of the room. I didn't know what to say. She is still a person. Just go with that.

"Oh, Ms. Geraldine," I said softly. It was all I could think to say. I placed my hand on top of hers and smiled. "You know, Ms. Geraldine--I always tell my kids this--'You were fearfully and wonderfully made.' It kind of means that we are all special. The same goes for you."

"Your kids is lucky," she stated wistfully, "I bet you they feel good about who they are." Wow.

I tapped my foot on the floor beneath the desk to let out the emotion mounting inside of me. This is not fair. This is so whack. This is the part of my job I intensely hate and love at the same time.

"I sure hope so, Ms. Geraldine," I sighed. I looked her in the eye and placed my hands down firmly on the desk. "Let's do this. How about you keep your appointments with us, and see our social worker, Ms. Beasley today? We'll take this thing one day at a time, okay?"

She smiled wide and nodded. "One step at a time," she cosigned.

I shook her hand and walked over to the door. "And maybe when this is all said and done, you'll feel good about who you are, too, Ms. Geraldine."

"'Fearfully and wonderfully made.' I like that. I'm gon' remember that, doctor."

***

There are sometimes those days caring for patients in a public hospital like Grady where you feel like a tiny ant gazing upward at the Mount Everest of medical problems--without so much as one rope or one pick with which to climb. At those times, I try to remember what I always tell my medical students and myself: Patients are people. Patients are people. Patients are people. This is where we all intersect; different lives, different upbringings, different cultures, different circumstances--but all people with wishes and hopes and dreams. Remembering that human aspect and tapping into it can be the first step. . . . .and sometimes it's the only way to empower our patients to conquer their own mountains.

". . .I am fearfully and wonderfully made;
Your works are wonderful,
I know that full well."

~Psalm 139:14

Reflections from the day after an allegedly "bad" day: Keep your joy to yourself

I did not sleep very well last night. My mind was racing way more than is compatible with a good night's rest. For multiple reasons, yesterday wasn't my favorite day, which is really unusual considering every day is usually my favorite day. A series of events stacked on top of each other and did the unthinkable--it ruined my day. But like the Pollyanna that I am, I stayed up all night coaching myself into believing that this new one would be better.

All that coaching was exhausting. Zachary appeared on the side of my bed at 6:45 a.m., and it felt more like 1:45. Now he has mastered opening our bedroom door and climbing into our (very high) four poster bed. He patted my face and, trying his best to whisper, said, "Mommy, you awake? You eyes are open." He straddled my chest and pushed his nose into my face. Again the baby baritone whisper. "Mommy? Mommy!" I sat up and pulled him into my chest. His little boy smell gave me just enough energy to get out of bed.

I headed into the kitchen to start breakfast and coffee as Zachary scampered into the playroom. I could feel myself dragging. I felt like a robot, reaching for coffee, Splenda, and creamer without even thinking about it. I nuked the kids some microwave pancakes (one of the best inventions EVER), and pulled a container of fresh strawberries from the refrigerator. As I sliced the tops off of the fruit, I got caught in another mind-racing tailwind. I let myself replay parts of the previous day that I didn't like, which is never smart. I nearly cut myself when Isaiah snuck up behind me, pulling on the back of my t-shirt.

"Mommy, are you still sleepy?" he asked earnestly. "You look like you are still sleepy. Or sick." Aaaah. From the mouths of babes.

I turned around and looked at his innocent little face, complete with early morning eyecrust and dried something or other on the sides of his nostrils.

"Hey there, sunshine boy," I answered softly. I offered him a half-hearted smile. Then I decided that I would just talk to him "regular." " No, sweetie, I'm not sick. I just didn't sleep so well last night."

"Why not, Mommy?" (Of course, that's what he said. I asked for it.)

"Mmmmmm. . . .I don't know. I think I was just thinking too much."

"About what?" (Again, another predictable response.)

"I think I was thinking about a lot of things. Sometimes Mommies just think about a lot of things, and then it is hard to sleep. I didn't have a really good day yesterday."

Isaiah just stood there staring at me for a few moments. "You mean like Alexander?"

I cocked my head and gave him a puzzled look. Then I realized to what he was referencing. He was talking about Alexander from the book "Alexander and the Terrible, Horrible, No Good, Very Bad Day." The main character of Judith Viorst's classic children's book spends the entire tale lamenting about his terrible, horrible, no good, very bad day. Nothing at all went right for him on this day. Nothing. And the book ends not with him suddenly finding a pot of gold, but instead with his mom simply telling him (after he threatens many times to move to Australia) that sometimes days are just bad (even in Australia.) At that point, I decide that I like Isaiah's point of reference.

"Yeah. Kind of like Alexander," I chuckled. I shook my head and returned to the strawberries. It amazes me the things that comes from that kid's mouth.

"Mommm-myyyyy. . . . " Isaiah sang my name with a big smile creeping over his entire face,"I bet you I know something that will make you have a great day today!" He grabbed my hand and quickly pulled me from the kitchen into the sunroom. He clapped, laughed, and pointed out of the window. "Look, Mommy! Look!! SNOW!!! Mommy, Snow!!" He began jumping on the couch and dancing like a four-year-old madman. The sight of him dancing about a half inch dusting of snow in Atlanta already firmly placed this day ahead of yesterday.

I remembered that school was supposed to be closed due to threat of snow, but I guess I didn't expect for any of it to stick. It's nothing for an Atlanta weatherman to belch something that sounds like the word "snow" and for every school within a fifty mile radius to shut down. After living in Cleveland for five years, I think I know what a real snow day looks like--and this ain't it. A few minutes later, Zachary sprinted into the sunroom and joined the madman dance party. They sang in unison while shaking their bottoms, "It's snowing! It's snowing! A - boo! A - boo!" (My kids pretty much make that the song they sing for anything happening in their lives. Usually it's "I beat you! I beat you! A - boo! A- boo!")

"Guys, don't get too excited. It's not much snow. It probably isn't even enough to play in," I said, throwing my wet blanket over their celebratory snow day jam session.

"Yes, it is! Yes it is!" Isaiah exclaimed gleefully ignoring my Debbie Downer take on the weather. It was endearing. I thought about an elderly widowed patient I once cared for with severe arthritis who was always smiling. When I asked her how she stays so positive, she laughed and told me, "Don't never let nothing steal your joy." Looks like Isaiah subscribed to the same school of thought. I felt my own icicles beginning to melt as I watched them pressing their little noses and hands against the sunroom windows.

Now that I think about it, my day yesterday wasn't quite like Alexander's. There was nothing good about his day. But my day? My day included Isaiah and Zachary. My day included Grady Hospital, talking to my residents and students, and listening to NPR. It even started with one of my most favorite things--thinking I was scheduled to cover the clinic when I actually wasn't. (I'm still looking for a good word for that . . ."clinico-dipity?" or a "schedule-gasm?" Hmmmm.) Yesterday included a perfect cup of coffee, my favorite oatmeal from Trader Joe's, and laughing out loud with my girlfriends in the hair salon that afternoon. No, it wasn't all bad.

I sat across the table a few moments later watching the boys gleefully chatter about the snow over strawberries and pancakes. Not a care in the world. Suddenly, I felt a little ashamed for brooding. What exactly is a bad day anyway? Do I have any idea?

I once took care of a patient dying of AIDS who was the third child in his family to be losing a fight with AIDS. One older sister and one younger brother preceded him in death. Nope, not a family of hemophiliacs succumbing to some unfortunate aftermath of blood transfusions in the early days of HIV, but an inner-city family struck by something also hereditary--addiction and poverty. I thought about that patient's mother, who lived to see all of this. Losing one child is awful. Losing three children to anything, especially a preventable disease? Unbearable. Now this lady knows what a terrible, horrible, no good, very bad day feels like.

My kids and my job are both responsible for doing something very remarkable in my life. Both help me put things into perspective. Just about every day they help me redefine emotions like "happy" or "worried" or even "disappointed." Today was no different.

"Don't never let nothing steal your joy."

Isaiah was right, and so was that elderly patient.There was just enough snow for them to make snow angels, and watching them do so made this day quite the opposite of Alexander's--it was a wonderful, memorable, so good, very blessed day.

My angels making angels this morning. . .reasons to keep my joy to myself.