Reflections from a Tuesday at Grady: Up on the Roof

Up on the roof (of the Grady Parking Deck -courtesy of my iPhone)

"When this old world starts a getting me down,
and people are just too much for me to face.
I'll climb way up to the top of the stairs
and all my cares just drift right into space.
On the roof, it's peaceful as can be
and there the world below don't bother me, no, no. . . ."

from James Taylor's rendition of "Up on the Roof"
(written by Carole King and Gerry Goffin)
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Up on the roof. . . . .

I had an evening meeting recently and didn't get a chance to leave Grady until it was already dark. As I crossed the street from our office building to the parking garage, I suddenly remembered the craptacular parking lot karma I'd had that morning--translation: I had to park on the tippy-top level of the garage. Uggghhh. Could hear Harry in my ear: "You better have somebody escort you to your car! I mean it, babe! Don't be crazy!" Seeing as I pride myself on being a good (and noncrazy) wife, I went ahead and asked a kind security officer to join me up the elevator and see me to my vehicle. And just as I would expect of our smiling brigade of parking garage security officers, my request was granted.

The doors immediately opened when I called for the elevator car; not unusual for an after hours lift at Grady. "You must've gotten here late, doc!" teased the officer as I pushed 9 on the key pad.

"Not too late," I replied with a chuckle, "I just had pretty bad parking lot karma this morning. I'm telling you I circled this puppy up and down for fifteen minutes hoping somebody would pull out, but no luck." The officer smiled and gave a knowing nod.

We stepped off of the elevator and into the cool evening air. I gestured to my lonely car in the furthest parking space from where we stood. Without speaking, the officer and I paused for a moment, then looked at each other and laughed.

"Dang doc! They got you in the corner pocket!" He cocked his head to the side and gave me a playful eyebrow raise. "I don't care what you say, doc, you got here late."

"Me? Late? Never!" I laughed out loud at my own joke. I pulled my bag up on my shoulder and strolled out onto the asphalt. My feet were tired, and these crippling three inch pumps (that sounded like a good idea at the time) would be kicked off and thrown in the back seat the minute I reached the car. I could hear my heels clicking across the lot, and felt the vibration of another car rolling down the ramp below me. The officer stopped midway and watched as I made my way over to the truck. Whew. I was secretly relieved as my car was (and still is) offensively dirty. Again could hear Harry asking one of his famous rhetorical questions: "Babe, I just have one question. Were you planning on just keeping your car as dirty as possible on the outside. .. . or. . . " (Nothing ever comes after the "or".)

Just as I reached my truck, I dug around in my purse, grabbed my key and then glanced up for a moment. . . . .what I saw made me freeze in my tracks.

Gasp.

I was suddenly struck by the breathtaking evening view of the Atlanta skyline.The lights were sparkling like a well-lit Christmas tree--spectacular. For some reason, it was like I was seeing it for the very first time. I whispered audibly,"Wow." I reached into my pocket, pulled out my iPhone and snapped a fuzzy picture of it. Even though the picture doesn't do the sight any justice, I like that it serves to remind me of that moment. I peered back over my shoulder at the kind Security officer who'd graciously escorted me up and waved. Thanks. Once I was safely inside my locked car, I threw my high heeled shoes onto Zachary's car seat, turned the ignition and then just sat there for a few moments . . . . .creating my own mental postcard. Sigh.

Today I am reflecting on how crappy parking lot karma became a sweet little gift. Wrapped in a dusty bow, I was treated to a moment of solitude. . . .leading to an appreciation for just one more thing, albeit small and unexpected, that there is to love about working at Grady.
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Now this will be the theme music I play in my head when I have bad parking lot karma at Grady. . . .aaahhhhh. . . .up on the roof. . . . . I just love James Taylor, so initially chose this one, but admittedly my internal theme music alternates between the JT version and The Drifters version (below.) . Which do you like best?. . (I know what my dad will say already!) .

Quick Reflection before Bedtime: Finding the Fun

"Practice-Based Learning and Improvement" --wait, huh?

Practice-Based Learning and Improvement--That's what the ACGME (Accreditation Council of Graduate Medical Education) calls the most confusing of the six "core competencies" that ALL resident doctors must achieve prior to being released to the world as bonified and sho' nuff physicians. There's this whole fancy definition used by the ACGME that, once you break it down, actually isn't as confusing as it sounds. "Practice-based learning and improvement" really means being a life-long learner, reflecting on what happens around you good, bad or indifferent, and (duh!) looking stuff up when you don't know the answer and applying what you learned later. Even still, as soon as somebody attaches these concepts to the term "practice-based learning and improvement" everybody breaks out in a cold sweat, scratches their head and asks, for the thousandth time. . . Practice-based who and what?

Whether we get it or not, it's our job as medical educators to get our learners proficient at being. . .well . . .learners. . . .and not just any old learners, either--they need to be the life-long kind.

Isaiah and his 'brary card

I was pondering this the other day, and thought of a recent trip I took with my kids to the public library. On a rainy day, we splashed in puddles, sang songs, explored the stacks, found books. . . .had fun. Zachary even created his own "I got a 'brary card!" dance as we walked down the street in downtown Decatur to the frozen yogurt shop where we read books and ate fro-yo. What a delight! That's when I was reminded of this simple truth in learning and teaching: Find the fun. The more I think of it, the more I know this to be true. Every lecture, case, rounds, small group or workshop I've ever participated in as a teacher (or learner) that worked. . . was fun. And each one that didn't work, no matter how much preparation was involved, was not.

Learning with a Dr. Seuss Board Game

So. . .how will I try to get my residents and medical students to be "life-long learners?" It's simple. The same way I'll get my kids to be life-long learners. By finding the fun when I'm teaching. . . . and then helping them to find it for themselves when they're learning. No matter how complicated you try to make it sound, or how old you are. . . . the fun is always in there somewhere. . . . .you just have to find it.

Finding the fun for themselves. . . . .

Reflections from a Clinician-educator on Match Day: The excitement never dies. . .

IN DEBT? Maybe.
GAINFULLY EMPLOYED? Sho nuff.

"You did it!!"
(with advisee and M4, Bianca S., Emory SOM Match Day)
March 18, 2010

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"Match Day"

Different specialties debated
Some must be negated
Anxieties inflated
A choice finally stated
(Though sometimes belated)

Applications created
Arranged and collated
Interviews slated
And, as much as you hate it,
The game--you have played it
A list signed and dated
For this day long awaited. . . .

Your fear, concentrated
The heart, palpitated
Your work, culminated
You'll learn what is fated. . . .

The verdict is stated
Most are elated
A few, devastated
(Or inebriated)

All, liberated
The foundation, you've laid it
Go ahead and parade it
And, of course, celebrate it
You've finally made it!

- Dr. M
3/2010

Congratulations to all of the extraordinary senior medical students on your bright and exciting futures -- and the mamas, daddies, aunties, uncles, grandmamas, granddaddies, husbands, wives, girlfriends, boyfriends and entire village that got you there!

Go ahead and parade it --and of course, celebrate it! (Lawd KNOWS we did. . . . .)

Match shenanigans circa 1996

Me as celebratory M4 on Match Day-- March 20, 1996
(That was H20 in that cup, Mom and Dad, I promise.)

The excitement never dies. . . . . .

Reflections from a Grady Doctor in NYC: Skyscrapers and ev'rythang!

*Ode to my friend and fellow Grady doctor, Neil W., who is always in a New York state of mind

Okay, so I took a brief trip to New York City for less than 24 hours this week for work. Usually, I limit my blog posts to Grady or at least the state of Georgia, but New York City is a trip. What's cool about it is this. . . .if you aren't from there, every time you go is like the first time. As soon as I arrive, the first thing I always say is a line from Stevie Wonder's "Livin' for the City":

"New York! Just like I pictured it! Skyscrapers and ev'rythang!"

I texted that line to my friends and family. My friend Lesley M. (also a bonified, born and raised New Yorker) promptly replied by asking if I'd ever been to New York. Explained the Stevie Wonder thing to her best I could.(No worries, Lesley, that song came out in 1973.) My brother, on the other hand, second only to my sister Darlene in his mastery of all things random, rapid fire texted back the next three lines from the song. That is so Draper family.

Things I heard in less than 24 hours in the city:


Riding in the car:

"Hey! What are you? Some kinda moron? Get outta da road!!" He rolls his window up, looks over his shoulder and then smiles at me--sweet as pie. "How you doin'?"

In Starbucks:

"Aaay! Let me get a red eye, grande!"

"RED EYE! GRANDE! WHO'S NEXT!!"

"I'm next. . I'm next. . .Let me get a Black Eye, The Big One."

"YOU MEAN A VENTI?"

"Whateva is the big one. The big one, that one, the big one . . .Venti Vidi Vici! Geeze, the big one." Hilarious.

"BLACK EYE! VENTI!" Love this.

I scan the entire menu. Nothing anywhere says anything about any red eyes, blue eyes, black eyes or any eyes whatsoever. Against better judgment I ask Red-eye lady:

"Excuse me. . . .uh. . . .what is a 'red eye?'"

"WHAT'S A RED-EYE!??" the Red-eye woman answers in unison with Starbucks barista who overheard me asking. (People in New York talk loudly, but for some reason, no matter how softly you speak, they hear you, and then repeat what you said in Dolby Stereo for all who didn't.) "Uh. . yeah. . .I don't see it. . " I look up at the menu and point. Red-eye lady, Dolby-barista, and Black-eye bully all laugh. . . .but nice thing. . .sort of with me, no at me. Black-eye Bully says, "Red eye is a cup a joe with a shot of espresso. Black is a cup a joe with two shots of espresso." I say, "Why would anyone want two shots of extra espresso in the biggest cup of Starbucks coffee?" Red-eye lady, Dolby-barista, and Black-eye bully all laugh again. This time at me.

And finally, grabbing a bite with a friend:

Just stepped into this little dive of a burger joint that felt very much like I was in the "it" place. Standing room only, folks everywhere. Only thing on the menu you can order: Burger, Burger + cheese, fries, shake (vanilla or chocolate.) Nothing else. Not gardenburgers, no grilled chicken, no nada. It's packed, so obviously, it is very good. With my friend, Natalie L., who suggested the spot and walked with me chic-ly with locked arms through midtown 'til we reached the place. Felt very Carrie and Samantha, especially because I was wearing 3 inch heels. (Forgot my flats.) Okay, back to the burger joint. People everywhere, no place to sit. Someone clears a booth and three swanky twenty-somethings slink over to sit down before we can. I am mortified when Nat looks at swank-a-licious trio and says: "Can we join you guys in this booth?" I am thinking, Is she crazy? This is New York! Fugeddaboudit! Then much to my surprise they say, "Sure . . ." The swank-a-licious trio scoots over and makes room for us totally nonchalantly. . .in their booth in a burger joint. Note: This is NOT a big booth. This thing fits two on each side comfy cozy, three on each side is kind of tight. But they didn't even flinch. "Sure, go ahead." I start making obligatory Southernly hospitable small talk, only to learn, I have lots to learn about New York booth sharing etiquette. After two or three short answers to my questions, Nat starts chatting away with me while noshing on her medium burger and our bag of greasy fries for two. Then I notice that swanksters are also chitting y chatting with not so much as a glance in our direction. They literally let us sit down--no obligation to chat. I whisper to Nat, "We don't have to talk to each other? That's so funny." Nat laughs and says, "Oh no. . .you can sit with me, but no, don't talk to me." It was incredibly odd. . .yet wonderfully entertaining and blogworthy.

I am now back in Atlanta, in the comfort of my "y'alls" and "yes, ma'ams." I do enjoy New York, though, and love any chance I get to visit. Even still I need some clarity. . . . .

Questions for my New York friends:

• Why do y'all talk so LOUD?
• Why does anyone need two shots of espresso in an already strong coffee? (Starbucks is, like, the strongest of the strong! Uggghh!)
  
• It's an oxymoron. . . why are y'all nice enough to let somebody sit in your personal space, but too mean to hold a conversation with them once they get there?
• Why do y'all have such great public transportation but still have horrible traffic?
• Seriously, why do y'all talk so LOUD?
  

Do tell. . . .

Reflections from a Woman in Medicine at Grady: What happens to a dream deferred?

LADIES FIRST. . . .

Rebecca Lee Crumpler, first African-American woman to graduate a U.S. medical school

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What happens to a dream deferred? Does it dry up
like a raisin in the sun?
Or fester like a sore--
And then run?
Does it stink like rotten meat?
Or crust and sugar over--
like a syrupy sweet? Maybe it just sags
like a heavy load. Or does it explode? ~ by Langston Hughes
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• In 1849, Elizabeth Blackwell became the first woman to graduate from a U.S. medical school in N.Y.
• In 1864, Rebecca Lee Crumpler became the first black woman to graduate from a U.S. medical school in New England.
• In 1915, women represented approximately 5% of the physician workforce in the U.S.
• In 1983, women represented approximately 1/3 of U.S. medical school matriculants.
• In 1976, Grady doctor and cardiologist Nanette K. Wenger is recognized as one of Time Magazine's Women of the year, and in 1998 she is named Chief of Cardiology.
• In 2006, women represented nearly one half of all U.S. medical school matriculants and graduates.
• In 2008, my medical school classmate Yolanda Wimberly wins the prestigious AAMC Humanism in Medicine Award
• In 2009, my colleague Lisa Bernstein becomes the youngest and one of few female recipients of the Papageorge Teaching Award, one of the highest teaching awards attainable at Emory University School of Medicine.
• In 2009, my colleague Stacy Higgins wins the Outstanding Clinician-Generalist Award, the highest honor given to a general internist at Emory.
• In 2009 and 2010, I celebrated the completion of residency training with fifteen women I supervise in clinic each week--only a small representation of the strong presence of women in residency training at our program, and women in the physician workforce.
• In 2008, I asked my preschool aged son, Isaiah, if he wanted to be a doctor when he grew up. His answer? "No way! I'm a boy! Doctors are girls!"

• You've come a long way, babygirl!

Grady doctor and Cardiology icon: Dr. Nanette K. Wenger, Professor of Medicine
still goin' strong. . .56 years after graduating from med school

Grady doctor Dr. Yolanda H. Wimberly, Meharry Class of '96
Doin' her thang at the Morehouse School of Medicine

Past and present women Grady doctors: Stacy H., Jada B-J, Ingenia G., Lisa B., and me
SGIM National Meeting 2009

Dr. Stacy Higgins wins Outstanding Clinician Award, 2009

Women as leaders: Grady Chief Residents 2008-2009, Dr. Paulina R. and Dr. Karen L.
(pictured here with Dr. Stacy H. and me)

Following Rebecca Lee's footsteps: 2009 Emory Internal Medicine Graduates
Aliya H., Angie R., and Tenecia D.
The Original Grady's Angels: Doctors, Mommies, and Friends
Me and Drs. Natalie Levy, and Lesley Miller

Brains and beauty: my seven senior residents from clinic,
Emory Department of Medicine Class of 2010
Christina P., Eva R., Rathi P., (me), Ayushi A., Sameera A., Julie E., Darina S.

More of Rebecca Lee's descendants
What happens to a dream deferred? It explodes!Meharry Girls, School of Medicine Class of '96
Dr. Tracey Lemon-Sams, Meharry Class of '96
Awesome OB/Gyn, Awesome-er friend
Esteemed catcher of both Manning babies (pictured with baby Zachary)

Dr. Erica B. and me, 2008 Emory University SOM
Deans Teaching Award Recipients

Dr. Lisa B. Bernstein, recipient of the 2009 Papageorge Distinguished Teaching Award
(a really, really big deal--case in point: last female to receive it? Uh, see Nanette Wenger, above. Hello?!)

Meharry Alumni, Tuskegee Alumni, and College sorority sisters
with Dr. Falona G.
Delta Sigma Theta Sorority Chapter Anniversary Celebration, Tuskegee 2008
The future is bright: Emory medical students, Hreem D., Antoinette N. and Carrie N.

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"Cause they see a woman standing up on her own two

Sloppy slouching is something I won't do

Some think that we can't flow (can't flow)

Stereotypes, they got to go (got to go)

I'm a mess around and flip the scene into reverse

(With what?) With a little touch of 'Ladies First'. . . ."



~ Queen Latifah, "Ladies First" circa 1989

Kickin' it Old School with a little "Ladies First" by Queen Latifah (before the acting career and Covergirl campaign)
~The original sistagirl's anthem!~

Reflections from the Culture at Grady: The "Air Apparent" Theory and other reasons I ain't goin'

*details changed in this story to deidentify patient and protect anonymity--based on an amalgamation of true events (xray from Google images)

"Yes, and how many times must a man look up
before he can see the sky?
Yes and how many ears must one man have
before he can hear people cry?

. . .The answer my friend
is blowin' in the wind
the answer is blowin' in the wind. . . ."

from Bob Dylan "Blowin' in the Wind"
 
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"I'm perplexed," said one of our residents, Christina P., as we sat in clinic one day. "Remember Mr. Porter, that guy that we got the chest x ray on that day? You know--the one that had the lung nodule?"

"Wait, why'd we get a chest x ray on him?" I asked while filling out a form our social worker had given me a few moments earlier.

"He'd been coughing--he's a pretty heavy smoker and had noticed a few blood streaks."

"Hmm. Sounds kind of bronchitis-ish, don't you think? Weight loss?" I thought for a moment. Oh yeah, that isn't what she was asking me. I chuckled at my tendency to digress, but paused when I looked up and saw the worry filling her blue eyes. "Wait--I'm sorry. . .what about him?"

She sighed and plunged her hand through her pin straight blond hair in frustration. "Well. . .I got him a chest CT, and then a CT-guided biopsy of the nodule."

I was confused. Sounded like she had done everything right. "Uh, okay and?"

"It's squamous cell lung cancer. Stage 1. Totally resectable. We caught it extremely early."

Um okay. "Wow. Fortunate that you thought to order that x-ray that I was giving you a hard time about." I smiled, but she didn't, which was unlike Christina. "Seems like good news unless I'm missing something, Christina. Have you told him? How did he take the news?"

Christina lay the chart down on the desk and shrugged her shoulders. "He's here now and I just finished seeing him. We spoke at length and he took it fine. Remarkably fine." She furrowed her brow and tapped her pen on the desk. "But. . . . he won't even let me talk about referring him to cardiothoracic surgery. I mean no way, no how. Before I even saw him, I had gone through all this trouble to get him an expedited appointment, but he was resolute. All he keeps saying is, 'I don't want nobody cutting on me.' "

"Hmmm. Do you mind me asking. . . .is he--" without thinking, I pointed at the brown skin on the back of my hand "--African-American?" Christina nodded. "Hmmm." We sat in silence for a few moments.

"Why do you ask?" The concern she had for Mr. Porter was painted all over her face. Christina and I had worked together in the resident clinic for nearly three years. Now, at nearly the end of her residency, our discussions about patients felt more like collegial chats than that between teacher and learner. Even still, I had a not-so-evidence based teaching point that I thought might apply here.

"Christina, have you ever heard any old wives tales about surgery and cancer? There is one belief, in particular, that is quite prevalent in the black community." I waited to see if she knew. "Any thoughts?"

She narrowed her eyes and thought for a moment, hoping some prior experience at Grady might jog her memory. "Hmmm. . . no. Not off hand, Dr. Manning."

"There's this thought that cutting someone open and letting air get to their cancer cells could lead to it spreading. It's a pretty prevalent belief," I told her.

I then reflected on a phone conversation I'd had several years ago with my late Auntie Mattie, who had been diagnosed with cancer. My Auntie Mattie was a stoic, tell-it-like-it-is woman who lived life with zeal. She was robust, smart, spunky, and always decisive. I was early in my training when she was being assessed for surgical intervention for her malignancy, and despite the years that have passed, I never forgot her words about refusing surgery.

"Ain't nobody cutting on me. I'll take the chemo, the radiation and whatever else they got, but ain't nobody cutting me open and letting the air hit my insides."

It was the first time I had ever heard this concept. I decided to explore it further with her. "What do you mean 'the air hitting your insides?' Everything in the OR is sterile, Auntie. The air won't infect you."

"I ain't worried about infections. Everybody know that when you cut open somebody with cancer and the air hit that cancer it spreads. Everybody knows that." No, Auntie, not everybody.

"Are you serious?" I asked while shaking my head and staring at the phone receiver. She cannot be serious. "Come on, Auntie Mattie. That's ridiculous. Air doesn't do anything to cancer." I waited for her response. Silence. "Auntie?"

Then she unleashed stories of at least 5 people that she knew personally who'd been diagnosed with cancer, had surgery, and then subsequently learned that it had metastasized (spread.) I kept trying to get a word in, but she wasn't budging on the theory. To her, it was apparent. Air. Spreads. Cancer.

Air--the devil in disguise

I have since had countless close encounters with the "air apparent" concept. And just like that day when I spoke to my Auntie Mattie, I feel myself turning blue in the face as I explain that sometimes people who get surgery for cancers are already pretty advanced in their disease, making the efficacy surgery limited. But much like my auntie, most of these folks are pretty firm in their position. Like my med school classmate Jada R. says, "Girl, she ain't goin'!" (The Memphis way of saying, "She ain't going for nothing you're saying.")

It turns out that Mr. Porter wasn't goin' for much of anything. Chemo? No'm. Radiation? No'm. Surgery? Oh hell naw, y'all ain't cuttin' me open.

Along with Christina, I pulled out every stop to explain how early his diagnosis was made, and how fortunate it was that this was the case. "Surgery could put all of this behind you," I implored. "You're not even seventy five, sir. And you're otherwise healthy." Silence. Sigh. "What does your family think about this, sir? Mr. Porter, have you spoken to them?"

"Yeah, and they said they don't blame me. 'Specially the surgery part." Take that, Miss Manning. Fifteen minutes later, I had to finally accept the obvious. Girl, he ain't goin'. At least, not today.

What Mr. Porter had in common with my Auntie Mattie is that he was senior-aged African American reared in the south. What's the significance of that? That's simple. Some pseudobarriers to health care are more cultural than anything else. Perhaps it has to do with growing up in a Jim Crow era where just about everything you received was secondhand, separate and no way no how equal. Or just maybe you read the paper in the 70's and discovered that less than two hours away from your home, men your daddy's age were being used as a big ol' human syphilis experiment. Then again on another day, it could be that your grandmama, and her grandmama before her--you know, the ones who told you that babies that "sit high" are boys, and that if your face and nose swell when you're with child, then "it's a girl all day," 'cause everybody knows that girls rob your beauty-- yeah, those same grandmamas who told you those pearls of wisdom also told you that being "cut on" was bad news, especially if it was cancer. Air + Cancer = Bad -- which by the time you turn seventy-anything translates to "Oh hell naw y'all ain't cuttin' on me."

Yeah. So just maybe your take on things isn't that you're ignorant or ornery or difficult or mentally ill. Just maybe it's cultural, and if somebody took two seconds to explore yours, they'd fully understand exactly why you ain't goin'.

I think it's our job to fold culture into our understanding of our patients just like blueberries into pancake batter. Every belief, value, and custom adds to the finished product--and when carefully considered, make for better doctor-patient interactions. And so, lucky for me, it turns out that understanding the souls of southern black folks is a perk--especially at Grady. Admittedly, as the child of a sixty-something year old African American Alabama natives, I was born into this understanding--- which sort of feels like cheating, but that's okay. Getting the "culture" dialogue going, no matter how it happens, is always a good thing. It opens everyone up to be authentic; which always makes things better if you ask me.

Learning about people and who they are, and then actually remembering what they say, is an act of love. And even though many might not think of their feelings for patients as "love," in my experience, it sure does make a person feel good when someone cares enough to explore more than just the basics.

"Lovely accent--where are you from?"

"Guyana. Guyana, South America."

"Right, that's near Venezuela, correct?"

"Wow, I'm impressed. Whenever I say 'Guyana', people think I mean 'Ghana' in Africa."

"Yeah, my last Guyanese patient schooled me, so I was ready for you."

*Smile*

Showing love. . . . .

Sometimes it's as simple as determining if a Chinese patient speaks Cantonese or Mandarin, or taking the time to find out if an African person who looks Ethiopian is indeed Ethiopian or instead Eritrean, or perhaps recognizing that all Spanish-speaking patients aren't Mexican--they just might be from Uruguay or Guatemala or even El Paso, Texas, or it could be remembering that your last Muslim female patient preferred not to see a male doctor, so this time taking it upon yourself to ask that nice woman in the waiting room clad in a hijab just who she's scheduled to see. . . .and yeah, sometimes it's simply acknowledging that beliefs run deep and can, literally, scare people to death. . . . like fear of the potential for air to make quietly hibernating cancers on the inside awaken to become ferocious, spreading beasts.

After every possible example, explanation, scary what-if, and usually persuasive hypothetical, Mr. Porter still didn't agree to see the surgeons that day. But he did say something to Christina at the end of that visit that I did find reassuring:

"I guess I'll thank about it, since y'all care so much and asking me so many questions. I never had nobody spend so much time asking me questions and caring about me like that."

Believe it or not, it's actually been studied, and it looks like air probably doesn't make cancer spread. . . . .but you know what I think does? Not listening and not caring. Being a little "culturally competent" just may be your only explanation for what otherwise would be completely perplexing--like Mr. Porter saying no to a potentially lifesaving treatment, and his whole family cosigning his position. . . . . .

. . . . .Thanks to Christina committing herself to trying to understand more than just the basics about her patient, she was able to evolve "I ain't goin'" to "I'll thank about it." And if you know the souls of black folks like I do, that's a pretty big deal. :)

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Food for Thought:

Never heard the "Cancer spreads when air hits it" theory? Google this: 

"if air hits cancer it will spread"

and see how many hits you get. . .or better yet, read this great NY times article from 2003:

Finding of Fact: Myth About Lung Cancer Can Be Deadly

Homework assignment:

Learn 3 things about 3 people of completely different cultures than your own this week.