Payback is a mother (and a father.)

names, details, etc. changed to protect anonymity. . . .

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"Seem like every generation have a little more chances."

~ A Grady elder

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Sometimes, despite my Pollyanna exterior, I just don't feel like doing all the things people ask of me. I open emails and see requests for all kinds of things and check messages that query if I can be here or be there . . . .and most times. . .it's cool. But sometimes, I just want to growl.

Grrrr.

Sometimes, it gets to be a lot. A whole lot.

On those days, I just want to run out of my front door screaming, "No!" (Or to set my email with an out of office reply that simply says, "No." And nothing else.)

Yeah.

That's why I love working at Grady Hospital so much. Every time I feel this way, something happens to right my thinking and put me back on track. To snap me out of my doldrums and give my soul a charge. To remind me of how much greater all of this is than me. In that way that only Grady can.

This was one of those times.

***

In the Grady clinic:

"Okay, Mr. Felton. Let's just recap all of this. You have the appointment to get your echocardiogram of your heart, the appointment with the cardiologist, and then depending upon what they say, we'll know what the game plan is for you getting the defibrillator put in."

This is what my excellent resident, Maggie, said to one of our Grady elders the other day in the clinic. We had come back to the room after their initial encounter where, after having me repeat a few key points of the physical exam and history, we were now wrapping up the complicated visit with Mr. Felton and his heart failure.

"Alright," said Mr. Felton with a smile. Even thought we'd welcomed him to sit back in the chair, he remained perched on top of the examining table like a regal hawk. His eyes were focused on Maggie's mouth as she spoke, almost as if he was reading her lips. I stood near the door taking it all in.

Mr. Felton had been feeling more and more short of breath. We already knew that his heart was very weak from his remote use of alcohol. Heavy drinking is one of the most common causes we see of dilated hearts that don't pump right. Mr. Felton fell into that category, and it seemed that the hollow pump in his chest was trying harder and harder to poop out on him.

"Mr. Felton, you are such a wonderful patient. You get an A+ for always following the directions we give you," Maggie affirmed. They locked eyes and smiled. "Now tell me, sir. What questions do you have for me?"

Mr. Felton zipped his coat and placed his weathered cap on his head. "I reckon I'm alright," he replied.

I finally chimed in. "Sir?"

"Ma'am?"

"Your doctor was telling me that you didn't make it to these appointments when we referred you a couple of months ago. How do you get to your appointments? Do you rely on Grady transportation?"

"No, ma'am. My daughter, she brang me to all my 'perntments."

"Oh. . . .okay." I paused for a moment. "Does she live with you, sir?"

"No'm. But she do see about me every day. She was gone out of town for a few days and she normally see about my mail. It backed up some, and I thank she didn't see the 'perntments."

I loved his pronunciation of the word "appointment." It was so Grady elder of him.

Maggie, being the intuitive resident she is and a person who has worked with her very predictable attending for the last two years, saw where I was going with all of this. "Mr. Felton? Sir, I'm not sure I've ever asked you this. How far in school did you go?"

"I went to 'bout seven. I mean grade seven."

She looked at me quickly and then back at him. "Sir, are you. . .able to read?"

"Yeah ma'am. I do alright."

Maggie caught my eyes again, searching me for suggestions. I thought for a few moments and decided to explore this further.

"Mr. Felton? We were just thinking about how much stuff we asked you to do today. It sounds like the appointments and directions can be pretty confusing. How comfortable would you say that you are with reading the things we send you or better yet your mail in general?"

"You know what? Tha's a good way to put it. I can read. But I ain't too comfortable with it at all." He chuckled.

"I hear you, sir," I said with a big smile. "There's a lot of things that I can do, but I'm not too comfortable with." Mr. Felton seemed to like this, so I went on. "Like. . . .I can mow the lawn in my front yard. But I'm not exactly comfortable doing it, and would be happy to let somebody else step in and do it for me."

We all laughed.

"I know tha's right!" Mr. Felton cosigned. He seemed tickled at the image of me charging around my grass with a roaring lawn mower.

"Mr. Felton, sir," I continued, "maybe we can work harder to make sure the directions we give are such that you can do them even when your daughter is out of town. That sound okay?"

"Alright."

Maggie went into the computer, and began to do just that.

"The echocardiogram--" she stopped mid-sentence and corrected herself. "--the ultrasound of your heart that tells us how strong your heart pumps--that's going to be on the second floor on Tuesday. One o' clock. You see the heart doctors or what we call the cardiologists at three o'clock on the same day."

I felt proud of Maggie. We had discussed health literacy numerous times, and the importance of taking a "universal precaution" approach to all of our patient communication by always using straightforward language and confirming understanding. Admittedly, this part of the encounter was not unusual. Many of our patients have limited literacy, and we know for sure that this can sure make it rough to navigate your health care.

Maggie diligently wrote the times onto a sheet of paper.

"Give this to your daughter,okay?" Maggie added a few more words and handed it over to him. Mr. Felton took the paper and held it back from his eyes.

"TUES-DAY ONE PM," he slowly read aloud. "THREE PM FOR THE H-HEART DOCTOR. SE-COND FLOOR."

We all smiled. Especially him.

I studied his long, leathery, espresso-colored fingers as they trembled while holding the 8 x 11 scrawled with Maggie's words. Then, I thought about what had just happened. He had just read the instructions--aloud.

Here's the thing: Mr. Felton was two beats away from his ninth decade and had only reached seventh grade. I was surprised at how well he could read, even if he wasn't always comfortable doing it. I immediately wanted to know more of his story.

"Mr. Felton? Did you learn to read when you were a child?" I asked.

"Nawww. I didn't even start school 'til I was round eight years old," he quickly responded. We listened in silence as he went on. "I remember that first day--shoooot--that teacher put five words up on that chalk board and I didn't know what it was!" He shook his head. "Back then, they didn't always make sure you could read. And if you missed school to work, nobody came looking for you, you know?"

Damn.

"Wow," I said instead. I hung on his every word, nudging him to continue.

"See, I'm from the country. When you come of age, they needed you in the field or if'n you was a girl, to see about the other chil'ren. School wasn't no guarantee."

School wasn't no guarantee? Damn again.

As my husband says, this was "real talk."

I imagined Mr. Felton as a young tween, waking up one day and learning that his school days were up. Exchanging his knapsack for a basket and a hoe to plow the field. Just like that. Whether he liked it or not. I felt an intense wave of gratitude for the evolution of the times. For some reason, the moment moved me in a way that caught me off guard. I found myself coaching away the tears that were gathering in the corners of my eyes.

Maggie spoke up. "So, then, when did you learn to read, Mr. Felton? That was awesome the way you read that to us."

"My daughter," he responded with a proud smile. "My daughter. When she was just a little thang, she taught me how to read. She showed me how to string all them sounds together to make words. And you know she wasn't even more than nine or so when she did. She would go to school and then come home and wont me to play school with her." He laughed at the memory. "She liked to be the teacher. And she still steady bossin' her Daddy around."

This punched me in the chest and brought even more tears forward.

Your daughter? Taught you to read when she was a fourth grader?

I couldn't take it. I was officially on the tippy-tip edge of crying and knew that if I didn't get out of there, I would blow.

Mr. Felton smiled and shook his head. "Seem like every generation get a little more chances. Here you are a doctor, teaching me about my heart." He looked me in my glassy eyes, warm and genuine. The tears pushed out onto my lashes as I drew in a deep breath.

Despite being on the tippy-tip edge of crying, I reached out and grabbed his hand. I had to. I needed him to know how thankful I was, and how true his words were. I wanted him to know that I was touching and agreeing with him, and part of me wanted to be infused with his spirit and his history.

There goes another punch to my chest. I had to get out of there.

I abruptly stepped away and put my hand on the door. "Okay, Mr. Felton, let me leave. You're going to make me cry."

"Aww, now don't do that, Miss Manning," he said with a chuckle. Maggie watched me carefully, knowing that I was serious. I turned my back before he'd know I was serious, too.

I indeed excused myself from the room and waited for a moment outside the door. I allowed myself a few seconds to process that exchange. I patted the corners of my eyes, and took a deep breath.

I regrouped and headed down the hall to see more patients.

***

This morning, I am reflecting on the evolution of time and opportunities, and all that it has afforded so many people like me. I am reminding myself of why I have been charged to do all that I have to do, and I am coaching myself to do as much as I can to live up to why I am here. It's so much bigger than me.

I am picturing my father sitting across from his high school counselor in a 1961 Birmingham, Alabama office, hearing that counselor say to my seventeen year old father in the clearest way ever,

"Don't major in biology or try to go to medical school because you won't get in. Go study engineering."

And him saying, "But I'm not very good at math."

And him replying, "Well, that's what you need to study if you want to get a job and not waste your time."

I'm seeing myself as a ninth grader, working on a science project with my dad the reluctant engineer, who meticulously helped me with every detail. And me telling him that I wanted to be a doctor some day, and him telling me that I will be a doctor some day. For sure.

Then I'm thinking of all of the love that had to go into Mr. Felton raising a daughter who would not only teach her father how to read, but some sixty years later, accompany him to every doctor's appointment-- and "see about him" every single day. I recognize it as the same kind of love that went into getting me to this very moment in time where I, a young woman of color who became exactly what my childhood dreams imagined, sat across from him, an older man whose dreams were limited by ceilings made of not just glass but cement. . . . .as his doctor. The doctor my father wanted to be, but was advised that he could never become.

***

I caught a glimpse of Mr. Felton's daughter holding the door for him along with a bag, his umbrella, and most importantly, his hand on their way out.

I look down at my stiff white coat, the stethoscope folded neatly in its pocket, and all it represents. I feel renewed, recharged and indebted to those who wished they could wake up to all of the things that I don't always "feel like" doing.

In that moment, I hear his words again.

"Seem like every generation get a little more chances."


Ah hah.

The reason why I have more chances.