Grady Seinfeld Episode: Put ya' hands up!

*name and minor identifying details changed

"Uh-uh-oh!"

- Beyonce "Single Ladies/Put a Ring on It"

“You’re gonna love this patient, Dr. Manning,” prefaced Steve V., the third year medical student that was working with me one month on the Grady wards. “No doubt about it. He'll be your F.P. today.”

Anyone who has ever worked with me knows that I always have an “F.P.” (favorite patient) every day. Usually the front runner gets trumped by one of the newly admitted patient (especially if they're a spunky, wisecracking elder.) But don't get it twisted--F.P. status is open to patients of all ages. I loved it that even my medical students were in on the F.P. game.

“Is he up in age?” I asked with a twinkle in my eye.

“No, not really. . . . he's only in his early sixties, but talk about a nice guy, Dr. M. You’d be hard- pressed to find another F.P. today."

“Well, I just can’t wait to meet him,” I replied while rubbing the foam hand sanitizer into my hands.

"I don't know, Dr. Manning. . . .he might even be an F.P. all-star.” This referred to the collection of elite patients I’ve cared for that were so wonderful, so memorable, so much of a joy to care for that they reached perpetual F.P. status. . . . kind of like the Football Hall of Fame, but without the ugly yellow blazer.

Steve launched into his seamless presentation of the man who indeed became my F.P. that day: Mr. Gables. As it turns out, Mr. Gables had relocated to Atlanta from Detroit, and was staying with his son here in Atlanta. Shortly before leaving Detroit, he’d had a series of health problems, including kidney failure which was ultimately complicated by an infection of his dialysis catheter. “Every thing was fine when I was in Detroit, but then it look like-it look-like everything went downhill when I moved here,” he told us on rounds that morning. “Now-now this catheter is all infected-and-stuff, and I-I don’t know what’s gonna happen.” His speech was kind of musical. Was that a stutter or an accent? If it was the latter, I couldn't place it. Is that a Detroit accent? Wait--what is a Detroit accent?

Steve was right. I liked Mr. Gables immediately. His infectious smile was the first thing I noticed when I approached the bedside. For a sixty-something year old man, Mr. Gables looked much younger. His gray hair was cropped close, and he still smelled of the shaving cream he'd used for his clean shaven face. Mr. Gables was one of those extraordinarily cooperative patients who helped you get to his body on exam by quickly untying his hospital gown and who took big, deep, exaggerated breaths each time the stethoscope touched his chest. Definitely an F.P. in every regard.

I looked at the dialysis "permacath" catheter that peeked from beneath a four by four gauze dressing on his chest. After peeling back the tape, a small push of the reddened skin with a gloved finger near the exit site of the tubing yielded creamy pus spilling from its borders. He winced. "N-n-now that. . that hurts right there." I still couldn't tell if he was stuttering, if this was indeed the "Detroit accent," or if he just talked fast. Whatever it was, I liked it.

"My bad, Mr. Gables," I apologized, "I won't mash it anymore." I listened to his heart carefully, and was relieved to hear no additional sounds suspicious for a blood infection attacking the heart valves. Steve and I carefully pulled his covers back over him after completing his exam. I nodded in Steve's direction and quietly allowed him to explain the plan for what would be done for Mr. Gables' infection.

"You were right, Mr. Gables," Steve started, "That catheter is definitely infected. The first order of business is removing it. We sent off the blood to the lab to see if it would grow bacteria or germs, and then we're also going to do an ultrasound or what they call an 'echo' of your heart. This will make sure that you don't have any infection on your heart valves." Steve looked at me, and I smiled reassuringly, nudging him to go on. "Are you following this so far, sir?" he asked.

"Yeah, I'm-I'm, yeah I'm with you," Mr. Gables responded, "but how y'all gon' do the, you know, do-the-dialysis if you take out the catheter?" I glanced downward, signaling to my student that he still had the floor.

"Umm, well, they're going to put in a temporary catheter and then we will replace it with the more permanent one. Eventually, we need to get you a one of those grafts." I liked the way Steve was learning to speak with authority, and how deliberate he was about avoiding medical jargon.

"You mean like the one they bury up under your skin in your arm?" he asked Steve before he could say anything further.

"Exactly," Steve affirmed, "but until the infection is cleared up, it isn't a good idea to put anything like that in just yet." I looked at Steve and raised my eyebrows; the closest thing I could offer to a fistbump.

"O-0-oh yeah, doc. I-I-I get what you sayin'. I tell you, doc. It seem like-like a brotha just can't-get-a-break." He shook head and sighed. Even though his words conveyed trepidation, his actions didn’t. Mr. Gables was as cool as a fan. He smiled easy and often, kind of like somebody relaxing in hammock in the middle of July. He asked good questions, and I could tell that he had good understanding of what was going on.

I decided to chime in. "Mr. Gables, the good news is that you are here where we can get to the bottom of all of this. We're all over this infection, and if there's anything you need or that isn't clear, just say the word. This guy will be taking excellent care of you." I smiled and gestured to Steve. "Steve's your man, okay?"

Mr. Gables chuckled and extended his hand to Steve. "Yeah-yeah. . . . .that's my-man-right there. . . that's my-my-man-hundred-grand," he said in my direction, and then redirected his attention to his young caregiver. "I-I- sho' 'preciate-you, Steve. You alright-with-me." A pink flush quickly spread over Steve's face. We answered Mr. Gables' additional questions, confirmed that he wasn't in pain, and then bid him adieu for the morning. My-man-hundred-grand? How could he not be my F.P. after a line like that?

And so, for several days our team cared for this wonderfully pleasant and musically fast-talking man from Detroit, or "the D" as he described it. Coming to examine him was like visiting a nice neighbor that minds their own business and doesn't get bent out of shape if your kids step on their lawn. His catheter was removed, his blood cultures were now free of bacteria, and one afternoon I stopped by to check on him after he'd just had the new permanent catheter placed. I decided to review his chart for a few moments before stepping in to see him. From the chartbox I could hear two men talking fairly loudly.

"Man, that Beyonce fine as a m@%&-f#%*r! And man! You seen her mama? Her mama fine, too!" I overheard someone say. The older male voice wasn't familiar--I assumed it belonged to Mr. Gables roommate, likely chatting with a visitor. I didn't even flinch when I heard the statement considering the myriad of similar comments I hear flying out of rooms and landing in the hallways every single day. I could faintly hear Beyonce's hit tune "Single Ladies" playing from both of their televisions.

"Yeah-yeah, man. . . . . you-you-ain't bullsh@$%in'!" a familiar voice responded. Wait- what? "Yeah-yeah-man. . . she might-might-not want no old cat like me, but-but-now-her mothaf$%@ mama? That's-that's a different story." Both voices erupted in laughter. What? Is that Mr. Gables?? Not my sweet, musical/stuttering/maybe-Detroit-accented F.P! Say it ain't so!

"Got dayum!" I heard my F.P. say to his roommate a moment later. "This-this-this is some bullsh@$%t! They-they-they didn't let me eat 'fore my procedure and I'm hungry-hungry-as-a-motha-f@$%cka! Shiiiiiii. . . they didn't leave a brotha-a-brotha-a-tray or nothin'!" I covered my mouth and gasped. Mr. Gables! I couldn't believe that was Mr. Gables with that potty mouth!


"Oh, man, they made you N.P.O.s? Yeah, thas some bullsh@$%!" his roomie responded using our shorthand term for "nothing by mouth."

"N.P. what? Man, somebody betta N.P.O. my moth-f@#kin' tray fo' I stick my foot up they ass!" They both exploded again in laughter with Beyonce repeatedly saying "Uh-uh-ohhh-uh-uh-oh-uh-uh-oh!" in the background. Uh oh, was right. How apropos.

I slid into the doorway like James Brown just as Mr. G. had finished his last colorful comment. He was sitting on the edge of his bed with his back to me, facing his roommate."Mr. Gables!!" I exclaimed. He quickly swung around, clearly startled by my voice. Once I saw his face, I decided I'd repeat it for emphasis. "Mr. Gables!"

He truly looked mortified. (His toothless roommate, on the other hand, didn't even flinch.) As a matter of fact, Roomie just poked out his lips and quietly nodded while surveying Mrs. Z (aka Beyonce) jaunting around on the music video still playing on television. (Like "Dude, you're on your own with this.") I didn't know what to say, so I said the same thing again. "Mr. Gables!" He could tell by the look on my face that I had heard him.

"Aww-aww-doc, you know I was just in here having fun," Mr. Gables said sheepishly. Then he suddenly looked worried and glanced over my shoulder. "Steve is with you?"

"Who? Your man-hundred-grand? Uh, no, thank goodness."

"Aww-aww-doc, I wouldn'ta said all that if-if-if I knew you was standing there."

I chuckled and said, "I bet!" I slipped on my gloves, looked at his permacath site and smiled. "Looks really good, Mr. Gables. I'll see if I can get you a tray, okay?"

He looked embarrassed and nodded. I couldn't resist poking fun at him before leaving. "That is. . . before you stick your foot in someone's you-know-what." He and his roommate looked at each other for a moment and then both doubled over in laughter. Beyonce's video seemed to go on forever. I could still hear her bleating "Uh-uh-oh!" Equally perfect timing.

Mr. Gables and his roommated could barely catch their breaths. They were having way too much fun for hospitalized dudes, but I must admit that seeing patients get along well with one another is one of my favorite Grady sightings. "That guy-that-that-guy-right-there is a bad influence, Miss Mannings. Switch-switch my room," he joked. We all laughed once more as I shook my head and waved goodbye.

Here is what I learned from Mr. Gables:

1. Don't sneak up on anybody or eavesdrop on their conversation. You just might find something you weren't looking for.
2. Nice people may secretly have potty mouths.
3. You can't judge an F.P. by how they look under the hospital cover--they just might cuss you out.
4. People from Detroit have interesting accents (or they stutter.)
5. More thought should be put into what we show on the televisions at Grady and how we arrange the roommate situation. (I'm just sayin')
6. Beyonce's mother is apparently really good looking.


Can't you see why I love this job? Uh-uh-oh!