Random Reflection on a Sunday: Sick vs. Sick-Sick?

"So I was the one with all the glory,

while you were the one with all the strength. . . . ."

from Bette Midler's "Wind Beneath My Wings"

_________________________________________________________

When I was an intern doing my very first rotation on the Internal Medicine inpatient wards, I remember hearing my senior resident say to me with her thick Latin accent and a mouthful of bologna sandwich:

"Keem, if you don't learn naathing else this year, you need to learn one thing and one thing only. Seeck versus not-seeck. Period. It doesn't matter how smart you are or how many facts you can regurgitate. It's all crap if you don't know a seeck patient when you see one. Sometimes the smartest thing a doctor can know is when they need to run like-the-hell and get some help."

"But we're in the hospital," I replied, "Isn't everyone technically sick?"

"Oh no! Definitely no. A lot of the patients in the hospital are not seeck at all. I mean they are seeck, yes. But most are not seeck-seeck. So now as-I-think-of-it, Keem," she added with her musical voice, "What you really need to know is seeck versus seeck-seeck." Oh Lord. Seeck-seeck? Nobody told me about that in med school.

"How do you learn it?" I really wanted to know. "I mean, is there something you suggest I read? Like maybe in the Washington Manual?" (In pre-internet-savvy 1996, that was the Internal Medicine intern's bible.)

She threw her head back and laughed. More of a cackle than a laugh. For a few minutes I thought she was mocking me. . . .but then she stopped abruptly. "Read?" She raised one eyebrow. "Oh no, Keem. You don't read naathing to know this. You leesten. You watch."

Okay. I think I was catching on here. This was one of those "Art of Medicine" moments. I was always intrigued with these sorts of teachable moments. "The senior doctors? I should listen to and watch the senior doctors, you're saying?"

"Keem," she spoke carefully with an icy glare (yes, I still remember and am amused by how she pronounced my name),"Keem, you listen to and watch the patient. And then . . .you always, always listen to and watch the nurses. Always, Keem."

Ummm. Okay. I'd heard countless times even before finishing medical school of the importance of remaining in "good graces" with the nurses. Be nice to the nurses, some resident would tell us as students, They can make your life pretty miserable or pretty wonderful. But the advice was always to befriend them, be collegial with them, and depending upon your personality and level on the totem pole, even brown nose them. But listen to and watch them just for the sake of learning how not to be an assassin? This sounded like a new spin.

"I've heard that you should always get in good with the nurses."

"No, Keem. Not that. I'm talking about real patient care. Leesten and watch. The nurses always know who is seeck-seeck first. They always do. Sure, don't piss them off. But leesten. Watch. Especially the really good ones. They always know first."

"Even before the patient they know?"

My resident folded her hands behind her head and rocked on the chair's two hind legs while balancing with her crossed feet on the conference room table. For a split second I feared she'd fall back and need stitches on her head, but she looked so relaxed that I turned my focus back to our conversation. "Even before the patient gives you the clue?" I reemphasized.

She continued her treacherous rocking. "Oh. . . well that depends."

I wasn't sure what she meant. "Depends on what?"

Suddenly, she slammed the chair forward and back down on all four legs. With both hands, she gathered her long, dark hair into a tight chignon and secured it with a pencil sitting on the table. With a knowing smile she said, "It depends on how much experience you have and how much you know. With time you understand more of the subtleties of patients. But long before that and long after you have the nurses--don't forget that." Aaaah. The nurses. Claro que si.

***

Turns out that this sage moment with my resident included some of the best advice I've ever gotten in medicine. . . . .

. . . so today, I'm reflecting on the hospital nurses. . . . . and all of the times they've both figuratively (and literally) thumped me on my head to alert me that a patient was indeed not just sick but sick-sick. I'm reflecting on the one who told me early in the morning before rounds that my patient had refused a lab-draw but not because he was ornery like all the other days he refused but because he was "out-of-sorts". And I'm remembering how "out-of-sorts" ended up being the first sign of septic shock (also known as "seeck-seeck")-- and ended up leading to an early intervention that ultimately saved a man's life.

Now, I'm more experienced. That conversation was over a decade ago, so, yes, I do pick up more on hints from patients that would have previously flown over my intern head. I'll take pause on things like, for example, when this nineteen year old girl with a sickle cell anemia pain crisis in her leg asked me for a bed pan one day. A nineteen year old wants a bed pan? That's weird, I remember thinking. Weird was right. It ended up being severe osteomyelitis (a bone infection) instead. And less than twelve hours after she asked for that bed pan, we confirmed it as such--all because of a simple request that just didn't sound right.

But how does one get there? I'm sure time, experience and a few key physicians help. But, in my experience, Lord knows the nurses played a key role. Like Priscilla, the nurse who used to pound her fist on the wall that stood between my call room and the PICU when someone coded because it was faster than paging me. As tough as she was, I learned quickly that I'd get much further working for her respect than of her fondness. It was with Priscilla that I learned, while chatting with her over tepid coffee as she charted her patients, countless things about really sick (and really not sick) patients that could not be found in books. Like when she taught me that people who say they are really worried about "something being wrong" are often right--even when the tests say otherwise. Or like when she showed me goof-proof ways to start and secure IV lines and when she taught me pearls like drawing blood too close to the IV line can screw up all your lab values or not checking the equipment (like unplugged O2) can make you worry for no reason. Sick versus sick-sick. Experience? Uhh, maybe. Nurses? Sho' nuff.

It's funny. Now that I think about that young woman with sickle cell anemia, I am reminded of what her nurse, Mrs. Nix, said that day after we'd gotten her down to the MRI scanner for her leg imaging:

"Dr. Manning, as soon as I saw that baby, I just knew something wasn't right. Nope. I was thinking during intake, This ain't just a pain crisis. Mmm mmm, no. That baby just wasn't right."

But of course. The nurses always know first. :)

***

"Art of Medicine" Teachable Moment for New Interns and Medical Students:

Sick vs. sick-sick? That's easy. Follow these simple steps:

1. Listen to and watch the patients. (Duh.)

2. Get some experience. (Double duh.)

3. Get enough experience to know well enough to never, ever overlook the warriors on the frontline--the nurses.
(They'll save you and the patients from stepping on a land mine.)

4. The good news is that when you listen to the nurses, they'll generally like you -- no brown-nosing required.

****

With respect, gratitude and admiration for all of my favorite nurses and all they've taught me . . . . .and for being there long before and long after I had a clue. . .
(I started to list your names, but realized it would be too many to list)~

Thanks for being the wind beneath our wings

(and the thumps upon our foreheads.)

Claro que si!


Wisdom from "Mother" Nix -- one of the best nurses I know. . . .

Reflections from a Friday: The Princess and the Peep-toe

"Mommy, who is that man with you on that picture?" Isaiah asked me the other day. I was on all fours digging into the back of my closet trying to find my other bronze peep-toe pump. Not that I was planning on going anywhere or doing anything. I just feel good in those bronze peep-toe pumps, and wearing them almost always automatically boosts my mood. I hadn't seen them since last summer, and realized that I needed them front and center should I need a "You go, girl!" moment.

"What man?" I called over my shoulder. "What picture?"

I still couldn't find my shoe which had now turned into an obsessive-compulsive adventure. Again, I wasn't going anywhere, nor was I planning to put them on right then and there, but this had not been a great self-image day for me. In addition to having a break-out on my face fit for a teenager working fries at Wendy's, I was also feeling frustrated that morning with my level of fitness. I discovered (and confirmed) that morning that I could definitely pinch more than an inch, and then made the mistake of stepping onto my bathroom scale while feeling critical of myself. Bad move. So for this reason, I needed to find my happy shoes. Knowing they were there, side by side in my closet, ready to provide me instant "it girl" status would make me feel better. At least a little better.

"The man in that book with you. Is he a doctor at your job?" Isaiah continued while doing random kung fu kicks and karate chops behind me.

"Bud, I don't know what you're talking about." I still couldn't find my shoe, and now everything was strewn on the floor in front of my closet. I felt bad that I was so distracted, but since Isaiah was clearly at least equally as interested in his self taught martial arts as he was his inquisition, I turned back to the closet to continue my quest.

"That man with the light face. Did he come to my birthday party?"

I looked on every shelf and in every box. Still no peep toe. Ugggh. I decided to start over and wade through the mess of sandals, boots, heels, and pumps scattered around me. I needed that shoe. Today had just been one of those days. One of those days when you make a mental inventory of every deliciously rich and fattening thing you've eaten all month with regret. I reached down and pinched my inch(es.) Uggh. I needed that shoe.

"What man with the 'light face'? Honey, I am not sure what you are talking about." I turned around and faced him while sitting cross-legged on the floor. Sigh. I could feel the big 4-0 creeping up on me faster than Usain Bolt.

Isaiah spun around, kicked, and then faced me with his best Bruce Lee pose and glare. He leaped out of the stance and replied, "With the hat on. That man with the hat on his head with you on the picture."

What? I squinted my eyes and shook my head. "Isaiah, what in the world are you talking about? Show mommy the picture so I can know what you're talking about." As I watched him dart out of my bedroom toward the living room, I rested my chin in my palms while leaning forward on propped elbows. I could feel that annoying breakout under my fingertips. Bleecchh.

That's when Isaiah skipped back into the room carrying an "Us" magazine. "Right here, Mommy," he said while pointing to the shiny paper, "Who is this man right here with you in the picture?"

I turned my head sideways to see the picture. Really? I looked up and into Isaiah's eyes, wide and earnest and then glanced back down at the magazine.

What I saw was better than my bronze peep-toe happy shoe, a visit to the hair salon, and my favorite dress all combined on the same day. It was Halle Berry. On a picture. In a magazine. Looking awesome. And my son--my insightful, bright, and inquisitive five-year-old son--looked at a picture of Halle freakin'-Berry, and thought it was me. Like really thought it was me. *~sigh~*

"Oh sweetie," I whispered, "that's not Mommy. You know that's not Mommy." But he pulled back and looked at the picture again with an "It's not??" look on his face--which warmed my heart, faded my blemishes, and unpinched my inches even more. He had no idea how much I needed that at that moment. I grabbed him and hugged him tight.

"Besides, I only like to hug you, Zachary and Daddy like that, so you know that's not Mommy," I added while squeezing him and tickling his tummy. His innocent laughter sounded like music.

"And Mommy you're prettier because you're the princess of our house and she's not, right?" He gave me an exaggerated smile complete with squenched eyes and every last one of his baby teeth gleaming like tiny white Chiclets (less the two missing at the bottom.) Then he planted a big kiss on my cheek, gave me one butterfly (eyelash) kiss and one Eskimo kiss. Unabashed affection-- fit for a princess. Before I knew it, he was off my lap and causing a ruckus in another part of the house. Just like that. Suddenly, finding my peep-toe pump didn't seem so important any more.

I stood up, walked over to the mirror, and smiled at my almost forty, somewhat frazzled, t-shirt clad, imperfect self. I curtsied to my royal reflection and said, "You go, girl."

Princess Me with my 3 Prince Charmings

Happy Feet

Reflections from a Sunday: Patients are People and Doctors are People (Who Both Need People)

*Names, event details changed. Based upon an amalgamation true events.

"But first, be a person

Who needs people

People who need people

Are the luckiest people

in the world. . . ."

-from Barbra Streisand's "People"

____________________________________________________________

"Charlotte, let me tell you about Mr. Evers, our new admission. I think he'd be a good patient for you to pick up," I said on the ward one day shortly after assessing this new addition to our bulging hospital service. Charlotte, the third year medical student working on my team that month, furrowed her brow and began digging around in her labcoat pocket for an index card and pen to take down the details. It was early in the rotation and our call day, and I thought he would be a great patient for her.

Mr. K.D. Evers was an elderly gentleman struggling with the harsh reality that salty foods and congestive heart failure don't mix. He was an excellent historian, and could tell you every detail of what happened in his past and present illness--all the way down to the "fall-off-the-bone ribs" he'd enjoyed at a cookout on Saturday and the "oodles of noodles" he'd eaten last night. "I jest started to huffing and puffing," he'd told me emphatically. "Then every time I called myself trying to lay down, look like I jest had to sit right back up on account of me being so short-at-the-breath." Could it get any better than that? A classic presentation of acute decompensated heart failure; wonderful bread and butter for a novice clinician.

"What was his chief complaint?" asked Charlotte with her pen positioned to write.

"Difficulty in breathing," I replied. "Here's his full name and medical record number. He's down on 5A."

"That's the telemetry (telemetry = heart monitoring) floor, right?" Interestingly this medical student seemed to need the answer to these questions before proceeding any further. I decided to oblige her.

"That is correct."

She dropped her hands to her sides, now holding the pen in one hand and the empty index card in the other. Her body language suggested that she wasn't as keen on the "pick up Mr. Evers plan" as I was.

"So, does he have, like heart failure or chest pain?" she inquired with the steely glare of a prosecuting attorney. Huh? This cross examination was a little puzzling (okay and, I'll admit it, irritating) to someone who trained during an era where you took all lumps and patients with minimal backtalk.

"Well, I can tell you this--he definitely has a heart." I chuckled, a kind of nervous chuckle considering my very first thought was, How 'bout you stop asking all these questions, go down there, see the patient, and find out. I cleared my throat and offered her a nondescript expression (it was the best I could offer.) "Here you go," I added while making another attempt at handing her the card with the patient information on it.

"But do you know if he has heart failure or chest pain?" she queried again, still purposely not reaching for the card I was trying to give to her. I rubbed my neck to summon some patience and to work out any knots that might erupt into snarky unprofessional replies.

"Charlotte, I won't tell you that. You just need to go down there and see him for yourself." We stood in silence for seconds that felt like minutes. This medical student was completely unfazed.

She sighed and finally spoke in something that bordered on whining. "I just want to know if he has heart failure or chest pain because if he does, I prefer to just wait for a different patient." No, I am not kidding. This is what she said--but wait, it gets better. Before I could even reply, she (I am not making this up) said, "Because I already had 'a heart failure' and 'two chest pains.'"

The needle scratched across the record, stopping all dancing on the ward. Whaaa? She cannot be serious. Wait. She is totally serious. Completely, undeniably, unapologetically serious. Seeing as I'm supposed to be an upstanding attending slash role model and all, I bit my tongue and wiped my hand (with the card in it) over my brow. Our service was really, really busy. My resident was in clinic, and we were admitting. I really didn't have time for this. I ignored the one or two responses that popped into my head, all of which included expletives. After a few seconds, I gathered my composure and spoke carefully.

"Charlotte," I said firmly while looking at his name on the card, "This patient, this gentleman is named Mr. K.D. Evers, and he was born right here in this hospital before either of us was born. In fact, he was born even before my father was born." I looked up and waited for her eyes to meet mine before going on. "He is a twin. And guess what his twin sister's name is?"

She looked very confused. Charlotte shook her head and shrugged her shoulders as if to ask 'What is your point?' I acted like I didn't notice.

"Her name is Queenie. Queen, actually. But everybody calls her 'Queenie,'" I continued. She opened her eyes wide and clearly seemed to be contemplating my sanity. I went on. "Have you ever met anyone named Queenie?"

"Uhhh, no," she answered quietly. Now her arms were folded, and I am almost certain this student was sure that her attending was at least a little bit crazy.

"Oh, you haven't?" I cheerfully countered, "Well, believe it or not, I have. I've actually met a few people named 'Queenie.'" I maintained my searing eye contact with the student as I kept with my story, continuing to ignore her perplexed expression. "Queenie, his twin sister, is a great cook and grilling is her specialty. She made some ribs on Saturday, which Mr. Evers loved. That's how I found out he had a twin sister named 'Queenie.'" You. Are. Crazy. (This is how she was looking at me.) I wouldn't be derailed. "And you know what? As soon as he told me he had a twin named 'Queenie'-- do you know what I said?"

"What?" Now Charlotte was obliging me.

"I said, 'Ah!' Now, I know what the 'K' and the 'D' stand for in your name, Mr. Evers!" I threw my head back and laughed. Charlotte responded with an uncomfortable tight-lipped smile that said, OMG. Crazy. Switch. My. Attending. I kept on going. "His sister's name is Queenie. Can you guess what the initials 'K' and 'D' are for?"

"Umm. . noooo," she answered while shaking her head slowly.

"See, my initials are 'K' and 'D', too. But, one, I'm a woman and two, I don't have a sibling named 'Queenie.'" I gestured with my fingers "one" and "two" and chuckled once more, this time a genuine chuckle. I was amusing myself.

"King David," I smiled and proudly stated. "His real name is 'King David' Evers, but they call him 'KD', sort of like a lot of my friends call me."

Charlotte squinted her eyes for a few moments and then couldn't resist asking. "But. . .how did you figure that out from his sister's name?"

"Because I had a King David before," I laughed, "and three Queenies. And all three of the Queenies were really named 'Queen Esther' on their birth certificates. And all of them were right around the same age as Mr. Evers."

"Oh." Charlotte cast her eyes downward. She looked back up when she heard my voice.

"Every single one of them was different, Charlotte. Every single one of them taught me something that I only could have learned from them." I smiled at her and put my hand on her shoulder. "Mr. Evers might have problems with his heart, but please don't reduce him to just his diagnosis, okay? He's so much more than that--trust me, I've met him--and I promise, he will teach you something if you just let him."

"I'm sorry," Charlotte murmured quietly, her face turning bright pink. Then she repeated in a barely audible voice,"I'm sorry."

"It's okay!" I chirped in sharp contrast to her whisper. I handed the card back to her. "Besides, he's an amazing guy. Just wait 'til you meet him!"

"Okay," she answered with new found vigor. She took the card with his information on it and stuffed it into her pocket. "Hey, Dr. Manning, you know what? I just thought of something." I cocked my head sideways and raised my eyebrows.

"I never had a 'King David!'" she cheerfully replied.

"And even if you had, Charlotte, you never had this King David." We shared a knowing glance before she scurried down the hall to meet her new patient--her second 'heart failure' and her first 'King David.'

***

Later that month, I sat down with Charlotte for end of the rotation feedback. At the close of our discussion, she brought up that exchange we'd had about Mr. Evers earlier in the month. She told me that she learned so much from him, and told me how ashamed she'd felt for almost missing out on the opportunity to care for him.

"Did you know that Mr. Evers had 2 other kids at his school named King David when he was growing up?" Charlotte asked me as we wrapped up our meeting. "And he knew 3 Queen Esthers, not even including his sister."

"No, I didn't know that." We both laughed.

"Oh, and Dr. Manning!" she gushed with a twinkle in her eye, "Would you believe his baby sister is named Charlotte? Charlotte! Isn't that funny?"

"That is funny!"

She seemed proud of her interaction with Mr. Evers and this experience really proved to be a pivotal one for her. I was glad that she'd had the chance to care for Mr. Evers and even gladder that she'd gotten the message that even the most seasoned clinicians sometimes forget: Patients are people.

Later that day, as I waited for the elevator, I imagined Mother Evers holding her new baby twins, King David and Queen Esther, some eight decades ago. I could feel a smile creeping over my face as I thought, Patients are people indeed. . . . .It's a good thing Mr. Evers didn't mind so much that he'd already had a Charlotte. :)

Reflections from a Wednesday: The Disconnect

Always connected: students in a lecture hall
(very similar to the sea of open laptops in our lecture halls in the med school)
________________________________________________________________

"So y'all didn't even have email addresses?" asked one of the medical students one day in our small group session. We were talking about things that are different now compared to when I was in medical school.

"Nope," I replied. "No email addresses and no cell phones either." Every student in the room gasped. I laughed out loud at their incredulous expressions.

"How did you guys. . . like. . .find each other?"

"Or like do anything?"

They all sat there shaking their heads, each of their faces lit up by the glow of their open laptop computers. I looked around the room at the students. Two were looking at iPhones, and another was plugging a jump drive into the side of his MacBook Pro. Wow. Things really have changed. When I think of my life now and compare it to my media-free life back in the early/mid 1990's, it does sound pretty funny. But somehow, it worked. Without cell phones, email addresses, text messages, facebook or wifi, it worked. It was life unplugged.

Although we were less "connected," the relationships we formed as medical students were anything but. I can still remember being an M2 sitting in Perkins Coffehouse with my med school classmate and bff-to-this-day, Lisa D. We'd order one "bottomless" cup of coffee, and then talk and study for hours. Depending on the proximity of the test and someone's heartbreak, many times it was more talking than studying. But no matter what we were doing, what it wasn't was interrupted.

What happened? When did everything get so urgent? Now, I'm embarrassed to admit, if I've walked out of the house without my cell phone, it takes me literally 3 minutes to realize the error of my ways. Why? Because now being "unplugged" feels. . .well, uncomfortable. You rationalize it and say things like, "Well what if there's an emergency? I'd need my phone." Then you turn around and go back home to retrieve it, shaking like an addict for the entire 4 minutes it takes you to get it off your kitchen counter.

The wakeup call.

As a residency program director, a few years ago I thought it would be a good idea to set up an anonymous, confidential email address for the house staff to provide feedback to me/program leadership without having to worry about repercussions or bad blood. So last week I get this email from the "mystery" email address that essentially says:

"At our case conference presentations, the program directors (program directors = me and another colleague) are seen regularly looking at their iPhones/smartphones. If you guys think these conferences and our presentations are so important then you should give us the courtesy of paying attention. It's so disrespectful."

Yikes. I immediately asked myself what my two favorite leaders (Harry and my daddy) would do in this situation--but the truth is, I didn't really need to. Here's the thing: I do look at my phone. A lot. I'm perpetually connected, and I've somehow gotten into thinking that I'd miss something important if I didn't double/triple/quadruple check my email every day. And yeah. . . . I do get a constant barrage of messages from residents, students, faculty, administration, GME, and family and have prided myself in my rapid responses to them all. However, deep down I know that very few if any of those emails are so urgent that they cannot wait an hour. In fact, most could wait several hours. There was only one acceptable response to this email:

"You are right. This is both disrespectful and unprofessional. We accept full responsibility for this and will do better." I typed the message to the entire listserve of residents (since I had no idea who wrote the original one.) I stared at it for 30 seconds, and then hit send.

Part of me felt embarrassed and exposed. I mean, here I am a "role model" being told to put down my phone like a teenage girl in the back of a classroom. Part of me felt proud that I had created an environment where the lowest man (or woman) on the totem pole was comfortable sending such an email to those sitting on high. Eventually a few days passed and the my feelings settled somewhere in between. All in all, I felt like I'd been thumped on the head. Hard. And sometimes a thump on the head is a good thing, and the only thing that gets your attention without harming you.

What happened?

I believed what I wanted to believe, that's what happened. Somehow I had convinced myself that it didn't look rude to be obviously preoccupied when someone was standing in front of the room sweating through their presentation. I allowed myself to believe that "surely they know how crazy busy and overscheduled I am and that although I'm looking at my phone, it doesn't mean I'm not paying attention." I assumed that they'd understand and not take it personally, which makes no sense because I would take it 100% personally were the tables turned. Like sometimes, I call my parents and read them something I've written. All 1,000 words of it. And I can tell, even over the phone, that they have stopped what they were doing, sat down, and listened to me from the first word to the last. And it always feels good and special when they do. Deep down inside, I knew that I'd been ignoring a little voice (okay, my mother's voice) that kept saying, "You know better than that. That's not okay and you know it."

Mobile Rehab?

Okay, so it would be lovely if I could end this post by telling you that I threw my iPhone into the Chattahoochee river and decided to just go commando with a land line only. Uhh, yeah, not quite. Instead, I am consciously listening and responding to the little voice. I am forcing myself to refrain from incessantly checking my email, and I'm also limiting my car-based phone conversations to hands-free calls in moderation. In fact, I'm already getting affirmation that it is the right thing to do, too. Isaiah told me the other day that he doesn't want me to talk on the phone to "anyone other than daddy or Ma-Ma or Pa-Pa" when we are in the car together. He meant that. "Even with your earjacks," he added. 3 year old Zachary chimed in. "Yeah, Mommy don't get on the phone, okay?" Dang.

So now my goal is to try to remember what it was like when my life was unplugged. To remind myself that I survived (and thrived) when there was no such thing as multimedia texting, hot-spots, or blue-tooth devices. To push myself to go over my girlfriends' houses more or sit with them in coffee shops over $1.79 bottomless coffee cups talking about everything and nothing instead of playing phone tag during our commute "windows." To hold my husband's hand and tell him face to face how wonderful he is instead of texting him with emoticons and smiley faces.

Today I am reflecting on a simple truth that somehow got lost in the apps and upgrades: The people in my life deserve my undivided attention. I deserve my undivided attention. Listening is an act of love--and respect. And I'm all about giving the people in my life both.

So to my anonymous resident whose frustration came across in that courageous email--Thank you. That thump on the head you provided was a good thing. Now I know for sure that the only way for me to stay connected in my life is to consciously disconnect from it more often.

Isaiah and his school mate: connecting the old-fashioned way :)



*Thinking about getting less connected?
Take Oprah's No Phone Zone Pledge.
I did. :)

Random Reflection on a Thursday: Maestro Moves and Jedi Nose Tricks

"Fruity. ..ah, yes indeed."

_________________________________________________________

"Hmmm. . . .fruity. . ." I overheard one of the senior Infectious Disease attendings say one day on the wards to a medical student. He waved his fingers around his nose in circles like a maestro, and then nodded his head. "Pseudomonas," he then said with the kind of confidence one uses when they tell you the sky is blue or the grass is green. Pseudomonas.

The student looked from left to right, and then did a quick scan of the area. She shrugged and looked back at the attending with a puzzled expression. I could tell she wanted to say, Huh?

Here's the thing: It's not like I overheard this exchange in or even near a patient room. This all went down at the nurses' station, easily thirty feet or more away from the nearest hospital bed. The Infectious Disease consult team had just emerged from the stairwell and had made a pitstop right by where I was writing my patient notes.

The minute I caught a glimpse of the senior faculty member leading their team of five other people of various levels of training, I immediately placed my pen down. Some of my best medical knowledge acquisitions have taken place via eavesdropping around the I.D. team. (Matter of fact, I'm convinced that this alone scored me at least four correct questions on my board recertification but I digress. . . . .) No matter where you trained, everyone knows that you can always count on the I.D. doctors to drop some random clinical pearls of wisdom even in idle chatter. And don't let it be one of the senior gurus--it's a veritable mother lode.

"Do you mean fruity like when people have diabetic ketoacidosis?" the student inquired. Nice, I thought, but clearly a rookie suggestion. Nice, though. I rested my chin in my hand and buckled my seatbelt for the ride.

You could tell that the ID Maestro was already foaming at the mouth with the beautifully packaged teachable moment he'd just been handed. He smiled wide. "No. . . this is a different kind of fruity. Almost like. . .a pleasant strawberry smell. Very distinct and quite different from that chemicaly-fruity smell that's often appreciated in ketoacidosis. This is more. . .how can I describe it. . . .fruity-fruity." Chemicaly-fruity? Fruity-fruity? Man, I can't wait 'til I'm senior faculty.


So, for my non-medical friends, I don't need to tell you that the hospital is teeming with all sorts of smells. When someone says "hospital smells," most layfolks probably think of typical unpleasant odors like vomit or urine, shuddering at the idea that hospital personnel are pretty much desensitized to such things. The truth is that, yeah, we are pretty much desensitized to the fumes of bodily excrement; matter of fact, those don't even count as "hospital smells" because they're a given. I'm talking about the other smells. The ones that no-way, no-how would the average person be able to assign an origin other than, "Sheeesh! What is that?"

Sometimes they waft by and disappear like vapor, and other times they accost you and tackle you to the ground. Most will tell you that the longer you work in the hospital, the more discerning your snout becomes (at least that's the going line we give to students.) To some degree, I'd say that's true. For example, the smell of a bloody bowel movement is one you only need to experience one time to get the gist of, but over time gets fine tuned. I'm pretty sure that some of my gastroenterologist friends can tell you just how much blood and even how many units of blood you'll need to transfuse to bring the blood count back to normal--all with one whiff.

Then there are the more sophisticated ones like the one the Maestro mentioned. That "fruity-fruity" business to which he referred often accompanies wounds infected by a kind of bacteria called Pseudomonas. "Chemicaly-fruity" notes might emanate from the diabetic patient whose sugar situation has gone horribly wrong. The question is, how does one learn this? I mean, it's not like anyone ever gives you a lecture in med school that involves smell-o-vision. Does the scent portion of medical knowledge comes with time, skill and experience? Does it?

I lifted my nose skyward and inhaled. Fruity? Nope. I couldn't smell anything. I inhaled again. No fruity, no fruity-fruity, no chemical-fruity--no nothin'. I took a few more careful, inconspicuous nasal breaths inward, this time flaring my nostrils. Still got nothin'. I decide that I will immediately stand and sniff in the same place where the Maestro is standing the minute he leaves.

Turns out I wasn't the only one with faulty senses. "I can't smell anything," spoke one of the fellows (fellow = specialist in training) on the consult team. He squinted his eyes, inhaled, and then shook his head. "Nope."

The Maestro waved his hand again welcoming the scent to his nares once more (which I am totally going to do when I am senior faculty whether I smell something or not.) "You can't smell that? That fruity scent? It's so distinct," he querried emphatically. "Like strawberries." Uhhh, or not.

After a few more moments of smelly chatter, the ID team disappeared into a patient room. I quickly jumped out of my seat and stood in the Maestro's exact place. Big inhale. Wait for it. . .wait for it. . . Nada! Another big inhale. Nothin'. Dang.

Fifteen minutes later, the ID consult team filed out of the room and immediately formed a semicircle around the Maestro (who was in the midst of an infectious disease teaching symphony.) "That odor is classic. Any time you smell that coming from a wound, think Pseudomonas. And that green exudate! Classic. Great case."

"But you smelled it the minute we stepped out of the stairwell! You didn't even need to see the pus in the wound!" said the student incredulously. "Once we removed the dressing I could smell what you were talking about, but how did you notice that from all the way over there?"


The Maestro offered a knowing smile, kind of like Yoda in Return of the Jedi. Because I am the Jedi Master, Young Luke. (At least that's what I thought he should have said.) Instead he leaned on the nurses' station and replied, "After a while you just sort of know. I guess it comes with experience." (Told you that's what we tell the students.) They exchanged a few more comments/teaching points and then left to see the rest of their patients. Finally, the coast was clear.

I stood up and sniffed. I took two steps closer to the patient's room and sniffed again. Still nothing. Hmmm. Maybe 14.5 years out of medical school is not enough time to achieve Jedi olfaction. Hmmm. Suddenly, a thought popped into my head. It was from a discussion I'd had with my faculty mentor, Neil W. during one of our meetings. He was telling me about how more than once, he's literally had his nostrils quickly tickled with that chemicaly-fruity smell of diabetic ketoacidosis during fleeting 30 second patient encounters. Most of them were there for completely different reasons, but just one whiff was enough to change the game plan. That was all it took to make him stick the person's finger for a blood glucose and have his hunch confirmed. "The nose knows," he proudly said that day. That afternoon we debated for a half-hour about whether the clinical smell thing is a matter of Jedi-level experience or simply a skill that some folks are born with. (Yes, these are occasionally the kinds of discussions I have with my mentor.) The jury is still out.


The evidence.

When my kids were still in diapers, I can recall busting through the front door after rounding all morning and immediately yelling upstairs to my husband, "Babe! Who stinks? Somebody needs to be changed!" The first few times this happened, Harry protested and assured me that everyone was freshly diapered and poop-free. Without fail, I'd march into the playroom, pick up each boy and-- phew--quickly hit the stinky jackpot. "How can you not smell that?" (To which he'd just shake his head and walk away.) This has always made me wonder if mommies are somehow hardwired to detect diapers that have exceeded their expiration. Harry says this is just sho' nuff and bonified proof that daddies weren't meant to be the purveyors of poo diapers. I'm not too sure I agree with that, but the point is that just maybe the Maestro and my mentor aren't Jedi smellmasters after all. Instead, they might just be carriers of some bizarre snuffoluffogus gene. Kind of like the ones mommies get on their extra x chromosome that allows them to detect a poo diaper upon turning into their subdivision that the daddy sitting two feet away can't smell.


Sniff. . .sniff. . .sniff. . .sniff. . .

Eventually I found myself standing directly in front of the doorway that the Maestro and company had just departed. I knew that actually entering the room would border on a HIPAA violation, so this was the end of the road for me. I pinched my nose to get it ready and then took one last big sniff. Nose don't fail me now! Iiiiinnnnn--and . . . .wait! I smell something! I folded my arms and leanded toward the doorjamb taking one more whiff just to be sure. Undeniable. Like the Maestro, no further evaluation needed.

I looked down the hall to Mr. Stanley, the nurse caring for the patients in that room. "Um, Mr. Stanley?" I uttered once he looked my way.

"Hey there, Dr. Manning! You need something?"

"Uuhhh, I don't, but I'm pretty sure someone else does. Mr. Stanley, I think someone in this room needs to be changed." I gestured into the doorway with my thumb.

"Really?" he asked, "I don't think so, doctor. I was just in there."

I stuffed my notes in my pocket, stood up tall, and patted Mr. Stanley on the shoulder. Pointing to my nose, I laughed, "Just trust me on this one, Mr. Stanley. Trust me."
_________________________________________________________

Reflections from a new beginning: The Graduate

The Complete Package?
It is what it is. Or is it?

my medical school graduation photo, circa 1996
(Yup, that's me with ALL that hair.)

"When you know better, you do better."

~ Maya Angelou

___________________________________________________________

The last few days have served as the celebratory swan song of our graduating medical students. Parties, events, gatherings, ceremonies. . . .it's a very festive time. They had a wonderful black tie dinner celebration last week, and I was honored to make the students' short list of faculty invitees. I felt terrible when I had to decline--but it was Isaiah's birthday that day, and I knew that (even though he was going to have a big party just two days later) home was where I needed to be. And so I said something like:

"Thank you for the invitation, but regrettably, I have to decline."

Sure, I fleetingly considered going for "just a little while" but knew that "just a little while" would turn into "Dr. Manning, you have to meet my mother" and then me looking at my watch and saying "I guess I can stay for the awards portion" and inevitably, a sheepish text message to my husband saying "I'm so sorry, babe, but it would be rude for me to leave. Be home soon as I can. xoxo." I felt conflicted that I couldn't be two places at once, but as terrible as I felt, I didn't allow myself to feel terrible enough to miss tucking my son in on his 5th birthday. And when I pulled the covers over him and heard him say, "Thank you, Mommy. I feel so special," I knew I'd made the right decision.

Colleagues and fellow faculty/mommies/Grady doctors, Joyce D. and Lisa B. in their regalia
at Emory School of Medicine Commencement, May 10, 2010

Yesterday was the med school commencement ceremony at Emory. It was, believe it or not, the first one that I have attended since joining the faculty in 2001. Watching all the students march in with their regalia on and with their families close by was quite a sight. The whole thing brought back tons of memories. Seems like only yesterday that I was the one looking in the mirror trying to perfectly position my cap. . . . . I remember much of that day quite well because it was pivotal for more reasons than just the obvious. . . . .

Two graduations in two days. . . .

When I graduated from medical school on May 19, 1996, it had been an exciting weekend. My younger sister, JoLai, had commenced from law school the very day before, and our entire family drove as a swift, proud caravan from her festivities in Birmingham, Alabama to my ceremony in Nashville, Tennessee. It was awesome. I'm talking really awesome. Pride oozed from my parents that weekend. I mean. . . . imagine how they must have felt. . . .literally seeing their two youngest kids finish professional school less than 24 hours apart! The third and fourth of their four children to receive terminal degrees. They could not stop smiling. Seeing how proud they were is a child's dream; the image is forever etched in my mind.

My classmates and I vibrated with excitement as we lined up and awaited our big moment. We graduated in this huge sports arena, but despite this, as soon as we marched into the large space, naturally, we each craned our necks with hopes of finding our families standing somewhere in the wings. Most could not make out their own amidst the sea of onlookers. Lucky for me, I saw my loved ones the minute I took my first few steps onto the slick wooden floor. There they sat in a row: my youngest sister, JoLai, the newly conferred juris doctor, my brother William and his wife, Francoise, who'd taken a similar walk in 1991 when they received their doctorates in Veterinary Medicine, ultra-proud Mommy and Daddy, both looking like they would vomit from the excitement, my oldest childhood friend, Kim B., and last but not least, standing on her feet applauding was my eldest sister and 1994 law school graduate, Deanna. That collective sight was moving. Everything about that moment said one thing to me: Complete. It should have been one of the happiest moments of my life. So why, then, did I suddenly feel so sad?

It is what it is. . . . .

Just two years before, my older sister, Deanna, entered her own professional school graduation and scanned an auditorium for those same smiling faces. The scene was likely almost identical--all were present, hooping and hollering, cheering and high-fiving--all but one member of our family: me. In May of 1994, I was in my final days of preparation for the first installment of the USMLE (U.S. Medical Licensure Examination) and was terrified to do anything that would take me away from studying--even for a moment. That included spending the weekend before the test with my family at my sister's law school graduation.

Interestingly, from the moment I made that decision until the day I finished medical school, I never felt like it was wrong. I deeply believed that this "sacrifice" was a necessary evil, and told myself (and my family) repeatedly that I just "had to do what I had to do." I was strangely proud of my resolve, and felt validated when I got notification that I'd successfully passed this critically important exam. I "did what I had to do," and "it is what it is" I repeated to myself and others over and over again. Although I was pretty convincing to most, a couple of people questioned me--but I could not be moved (or guilted) into doubting my rightness. Sure, my sister was graduating from law school, and sure, it was only a 3 hour drive away, but this is medical school, man. Medical school. Hey, man, it is what it is.

It was not until I placed my foot on that auditorium floor, head held high, and the room swirling with the first few notes of "Pomp and Circumstance" that something clicked. It did more than clicked. It clocked me in the head. The more steps I took, the more that fuzzy snapshot of my celebratory family quickly sharpened. That's when I got it. . . .the fact that all of my loved ones had made whatever sacrifices necessary to be there. . . . Will and Fran taking off from their busy Veterinary practices, Dad, Mom, and Deanna all flying from California, and Kim B. driving from North Carolina. It was like someone swiftly punched me in the chest, knocking my wind out. I gasped. How could I have not gone to my sister's graduation? I began asking myself. How could I not given her the experience of "complete"?

Now it seemed like Deanna was clapping in slow motion. . . . silently cheering and then exaggeratedly pumping her fist the closer I got to her. I could feel myself being strangled by shame and regret the more I watched her; genuinely proud of me and somehow forgiving the debt of me snubbing her from the very moment she was affording me. What's wrong with you? How could you have thought that was a good idea?

I cried throughout my entire ceremony, and got it together only to make my walk across the stage to receive my diploma. There is one smiling photo that I have seen of myself from when I'd left the stage (which I can't seem to find), but it in no way represents how I was feeling. My classmates all thought (being the drama queen that I can sometimes be) that I was overcome with emotion about finally becoming a doctor. What none of them knew was that I was in the middle of an "ah hah moment" and that I was learning a very important lesson.

My conscience was exploding: How could you have not been there? How could you have done this to her? You robbed her of her "complete". . . . and why did you think so little of yourself that you would actually believe that you could not have been there with your family and have done well? How can she be standing there clapping for you when you did this to her?

The thoughts were suffocating. I wanted nothing more than to get out of that seat on that row in that room and to run as fast as I could to my sister . . . .pleading with her and telling her that I was wrong. Terribly, terribly wrong. I repeated in my head what I should have said two years before: I'm so sorry. I should have been there. You mean more than a test. Our family means more than a test.

Later that evening, that's exactly what I did. I told her how sorry I was, and despite my best efforts not to, I cried hard right there in front of her (yup, the ugly cry.) Her response let me know how deeply hurt she'd been by my decision, and how long she had been waiting to hear those two words.

"It was only 3 hours away, Deanna," I eeked out between sobs, "3 measly hours. I should have been there, sister. I'm so, so sorry. . . "

"You didn't know," she replied gently, "You didn't know."

"Please forgive me." Suddenly I remembered how puzzled she sounded when I matter-of-factly told her that I wasn't coming during a brief board review study break phone call back in 1994. The thought of it made me cry even harder. "Please forgive me," I repeated. "I was so wrong. But you are right, I didn't know."

"I love you, Kimberly. Of course I forgive you," she said, "and I appreciate your apology. Even two years later. You have no idea how much I really, really appreciate your apology." She could of just said, "It is what it is." I continue to be thankful that she didn't.

What I know for sure

Deanna was right. I didn't know then but now I do know. I now know that I am smart enough and whole enough to do well professionally without shortchanging the other, arguably most important aspects of my life. I know that sometimes you do have to say "regrettably, I can't attend" but that there are also times that you must say "I will be there no matter what." I now know that "it is what it is" is no excuse for missing a milestone. As my former chairman, Dr. Blinkhorn, once told me before I moved to Atlanta, "There are times when your personal life must be paramount. The older you get, the more that is the case. The ones who seem to get this early seem to do the best overall." He was so right.

My hope for my students and residents is that they indeed care for their patients with all their might and attack all there is to learn about medicine with zeal, but never at the expense of family and important relationships. It's a bit of an oxymoron considering medicine is often a selfless pursuit. . . . . but again, it is those who maintain self who are able to give the most.

So in the end, my memory of graduation from medical school is bittersweet. Fortunately, I can say that it is more sweet than bitter. Beyond me officially becoming a medical doctor, it was a new beginning. . . . .and indeed a graduation. The start of me learning that honoring thy patient starts with first honoring thyself. . . . .and that honoring thyself involves honoring those who make your picture complete.

Me and Deanna at JoLai's law school commencement, May 18, 1996

Being there: Our COMPLETE family during another proud milestone
Grand Opening of Will's new veterinary practice, July 4, 2008



"When you know better, you do better."

~ Maya Angelou

Reflections from a (wait, am I a) Real Blogger at Grady: Greatest Hits?

Someone asked me the other day which was my favorite post on the blog to date. Hmmm, good question, I thought. I tried to narrow it down to one, but then realized that I couldn't. At first I was going to put my top three, but then admitted to myself that I couldn't do that either. Finally, I decided to include links to ten of the ones I most enjoyed writing and then re-reading myself.

I think what's hardest about picking a few is that each post represents how I was feeling at the time. . . .sometimes I'm feeling like laughing out loud and other times it's the complete opposite. The beauty in this exercise is that it has allowed me to create what feels like a set of love letters. . . . to. . . . well, my patients. . .and to my current life as a Grady doctor slash clinician educator slash wife slash mom. Writing about these stories lets me archive the details that I might have otherwise forgotten. . .especially the emotions. I like to think of it as free therapy, and a way to share the "burden" of hearing about all my Gradyisms and life-isms (good, bad, or indifferent) to more than just Harry! (Trust me. . .he thanks you.)

I'd love to hear about which have been most memorable for you! Thank you so much for reading and joining in this working mommy's journey through life at Grady and beyond. . . . .

Ten (of my personal faves) from the archives:

1.

The one about my picture on the Grady JumboTron

2.

The one about the Grady MD In/Out Parking spaces

3.

The one about when I started crying while giving Grand Rounds

4.

The one about the man who was frustrating me because he wanted pain meds

5.

The one about my patient with the flowers on her window sill

6.

The one with my patient with the perfectly groomed brows

7.

The one where the guy asked me if I could beatbox in front of Grady

8.

The one about David M.

9.

The one about when Harry and I met

10.

The one about when I didn't know the security officer's name

Shoot! Now I'm thinking of a whole set of ten others! (Like the one about CJ, oh, and the one about being called "Miss Manning", and the one about respecting thy Grady elders, and the one after the Haitian earthquake. . .) See? I love all of these stories. . . .

Would love your feedback on any posts you particularly enjoyed. . . .I was thinking of putting a list of "greatest hits" on the home page--and thought it would have far more street credibility coming from y'all!

:)

(Oh yeah, my favorite comment of all time was when Neil W. commented on the one where the patient asked me if I could beatbox--second place, Tony C-Q's comment on the one when I visited New York City. . . . hee-larious!)

Reflections from a Mommy at Grady: For Isaiah

The first time ever I saw your face. . .
I felt the sun rose in your eyes


And the moon and the stars were the gifts you gave
To the dark and the empty skies, my love

To the dark and the empty skies . . .






From Roberta Flack's "The First Time Ever I Saw Your Face"
_______________________________________________________

Isaiah,

You were due on Cinco De Mayo, but instead arrived on Seis de Mayo. . . either way your arrival was met with as much celebration. It was a happy day. . . .

You told me tonight as I tucked you in on your 5th birthday, completely unsolicited:

"Thank you, Mommy. I feel so special."

::Sigh::
This was my goal today.
This is my goal everyday.
Thank you for making me a better person. . .
. . .and for making me feel special, too.
I love you, Sunshine Boy.

Love,

Mommyxoxo

Mommy's five month old "Sunshine Boy"
Mommy's five year old "Sunshine Boy"

Elevator Observations: Keeping The Proper Focus

Auto-focus: It's magic!

I put on a knit top one morning and looked at myself sideways in the bathroom mirror. There was once a time when I never had to do the double-take. Pre-babies, my waistline was not my problem area at all. Fitted shirt? Bikini? Unforgiving knits? Bring it on, baby.

After having kids, that all changed. While fortunately, I managed to get the baby weight off, I have decided that post-baby bodies are sort of like sausages. Sure, you might get the extra pounds off and have the same amount of meat in the casing, but it's all squeezed into different places.

So here I was, doing a literal "gut-check". . . . trying to decide if this shirt was a yay or a nay. Admittedly, my take on the mummy-tummy varies from day to day. Some days I check myself out first thing in the morning and say, "Girlfriend, you look good for almost forty with two little kids!" Then, on other days when I'm, say, doing "planks" in my Body Pump class at the YMCA, I catch a glimpse of the weak-muscle-baby-abs aftermath in the mirror and shudder. (Seeing the twentysomethings next to me with their untainted, rock-hard cores of steel doesn't help, either.) That said, a second opinion is often necessary since I essentially vacillate between thinking I'm super hot or super not with nothing in between. Luckily, I have my very own Judge Mathis living with me when I need a quick small claims verdict rendered. "Hey babe!" I called out to Harry from the bathroom, "Can I wear this?"

Somebody doing the dreaded plank exercise

Harry has been with me long enough to know exactly what that means. Without so much as a "wear what?" he leaned back from where he stood in front of the ironing board, craned his head into the door frame of the bathroom, and squinted his eyes. "Yeah, you can probably wear it," he finally answered, "but you're definitely gonna have to focus."

Focus. "Focus" is our code word for holding in/sucking in things that might otherwise be mistaken for a bun in the oven or severe gas if you aren't careful. "I think this one might require more than just focus," Harry has often said to me as he packs his shirts for our annual New Year's Caribbean vacation. As many fathers reading this know, mothers aren't the only ones with the baby-weight and sausage phenomenon. Those sympathy pounds wreak havoc on the male belt size, too, and definitely affect a dude's ability to tuck in a shirt for sure. (That is, without some serious focus.)

And so, for me, "focusing" has become the prerequisite to non-empire waisted post-baby styling. Honestly, I think it applies to even the svelte-est moms--unless of course you're like, Demi Moore or that woman with like five kids and six-pack abs that hosts Dancing with the Stars. Most of us have to focus for at least 20 of the 24 hours in a day, depending on what we're wearing and where we're going. (I am actually convinced that Heidi Klum is not skinny at all, but is instead a master of focus. . . .but I digress) And yes, before you ask. . .some days, you just don't feel like focusing. Man, and I can't tell you how great a good ol' A-line no-need-to-suck-anything-in dress can feel on those unfocused days! But, for this day, I decided to go ahead and focus, and headed to work with the knit shirt.

After a fairly easy commute coupled with good parking lot karma, I grabbed my lab coat from the back seat, threw it over my arm and dashed into the hospital. I slipped into the elevator with a fairly buxom lady that appeared close to my age. She looked me up and down quickly before speaking. Here we go.

She pointed at me and mouthed an ah hah. "Yeah. . . . I seen you on Fox 5. You do good on there."

I smiled cheerfully and thanked her for the compliment. "Why thank you-- I appreciate that." We rode in silence for a few milli-seconds, which I knew it would be short lived.

"You got kids right? I heard you say on Fox 5 that you got kids." I kind of liked the way she said "Fox-Five" like it was one word.

"Yes, ma'am. I have two boys," I replied with a proud nod, "Three and almost five." Then I remembered where I was. The Grady elevator. I braced myself for what would come next.

"Oh. I was thankin' that you look good to have two babies." Whew, a compliment. I stand corrected. I was sure this was about to be a classic Grady elevator unintentional insult.

"Wow, thank you. You know, the closer I get to forty, the harder it is to stay in the same size! Especially after children."

"Girl, I know tha's right!" We both laughed and gave each other a high five. Then. . . .that's when it happened. An "only at Grady" moment. She (I am NOT KIDDING) patted me on my stomach. Did you get that? Patted. Me. On. My. Stomach. That's when the laughter ended.

"Yeah, girl, all you got left is a little pooch. You look good, though, girl for two babies. I be watching you on Fox 5 thankin', She look good to have babies." She cannot be serious. I really, really wanted to un-hi-five her. "But girl you know what the key is? Body Magic. You heard of the Body Magic?"

Seriously? Seriously? Did she really just annihilate me in the Grady clinic elevator? And wait--did she just pat me on (what I thought was a pretty decent looking post-baby) stomach--and then refer to said stomach as a "pooch?" Now THAT was low.

She went on. "Yeah, girl, Body Magic is the bomb." Please stop. Stop it now. "It really do make you go down two sizes." Wait. Is this really happening? She is not giving me a Body Magic info-mercial on the Grady elevator. Wait, do I really need a magic girdle? Damn. And can I just say for the record that I have no idea how she designated herself the pooch-police--although, from looking at her, she definitely had a clear pooch point-of-reference spilling over her jewel encrusted belt and tight blue jeans. Ugghh. Seriously? Seriously.

"Uhh. . .errr. . ." I was speechless. I mean, what do you say when in two seconds you go from local TV quasi-celebrity to being patted on your stomach and having it referred to as an (albeit little) pooch? A pooch? Really? And Body Magic? Really? Wow.

Thank goodness the elevator doors flew open. She spun on her heel and waved goodbye. "Keep doing your thang on Fox 5, doc," she said genuinely, "and for real, don't forget what I said about the Body Magic." Oommphh. Kidney blow! I watched her disappear down the hall and around the corner, and I was still speechless and still perplexed at her self-appointed authoritative insight on pooch-reduction (which clearly she did not think applied to herself.)

Suddenly, I was flooded with plenty of witty comebacks, but by then, it was too late--she was gone.

"Uhh, do YOU have on the Body Magic?"

"Yeah, girl. You DEFINITELY would know a pooch."
(or if I really wanted to get even)

"Congratulations! Do you know what you're having?"

Regardless of how obvious it was that my assailant was either a.) a hypocrite, b.) blind, c.) mentally ill and on her way to the Psych clinic, or d.) all of the above, I knew it was official. I had officially lost focus. Not even twenty minutes after arriving at work and my focus was already gone. (Usually losing focus doesn't happen until after a carb-heavy lunch.)

I called Harry at work later that morning to tell him about my assault in the elevator. He found it hysterical.

"What the. . . Body Magic? Whaaahh? What is that?" He was gasping and laughing so hard he could barely catch his breath.

"Apparently it focuses for you," I retorted. All I heard on the other end was "ah-ah-ah-ah-ah" or what the texting generation calls LMAO. "Uhh, look here, smarty. . . .they also have Body Magic for men." He laughed even harder at the very suggestion of that and then abruptly stopped.

"Wait, you looked it up?" he interjected, "What--were you gonna order it??? Babe! You ordered the Body Magic?!" His voice trailed off into what was now full-on juvenile cackling punctuated with his signature "Whooooooooo!" (or what the Generation Text would most certainly qualify as "ROTFLMAO.")

That's when I decided that it was good that this had happened because I was definitely overdue for a funny blogpost. And so, at the risk of revealing to all of you that, yes, I received a belly-pat and girdle recommendation on the Grady elevator by a perfect stranger, I decided that it falls into the category of suffering for the arts. (Kind of like how Usher makes better music when he has a horrible break up or a divorce, or how Mary J. Blige made such great CDs back when she was miserable.)

So, thank you, crazy-Body-Magic-lady. And thank you, too, little pooch. I couldn't have done this without you. Oh, and for the record: No. I did not get the Body Magic, thank you very much. For now, I think I'll just stick with my planks and work on my focus. :)

(As it turns out, sale of this magic girdle is a multi-level marketing thing,
so perhaps it was NOT my pooch at all, but instead just a business move--right?
At least, this is what I've told myself.)

Grounds for Divorce:
A Man-Girdle? This is just wrong, dude.