Rounds with Roy A.

One of my favorite ward months ever was with Roy A. (who later became one of our chief residents.) He was (and still is) what I like to call "scary-smart." Kind of like my friend Lorenzo D. (the one who inspired the term.) Anyways. Today I thought of scary-smart Roy A. and all that he taught me that month. I amused myself thinking of the look on my face every day on rounds with Roy. Lawd. The things he came up with! I'm talking the most obscure of the obscure to the most relevant of the relevant. No matter what it was, Roy knew at least a little something about it. And. . .dare I say it? A whooooole lot of times he knew more about it than his attending.  Sure did.  

That Roy. He was so bright and fun to work with. Man, I learned a ton from him. Yeah, I said it. I learned a TON from him, my resident. Sure did.

You got a problem with that?

Here's a re-creation of me on wards with Roy A. . . . .

At the end of the month, Roy said, "Oh, Dr. Manning! I learned so much working with you! Thank you so much!"

And I was thinking, "You learned so much? Uhhhh, okay."

***
Happy Thursday. Oh--where is Roy now? Somewhere scaring the stethoscopes off of the Cardiology attendings in his Cardiology fellowship as we speak.

Grady Verbatim: What have you done for me lately?

This weekend on rounds at Grady:

"You haven't done NOTHIN' for me! NOTHIN'! I mean I know you SAVED MY LIFE and all THAT but OTHERWISE? You haven't done NOTHIN' for me!"



Ummm, okay.

***

White coats and questions.

*story shared with permission.

On Saturday, our first year medical students received their very first "white coats" in a symbolic program called "The White Coat Ceremony."  Family and friends came from near and far to witness the event--okay and maybe. . .just maybe. . .to lay eyes on their children and see where all of their money is going.

The day was beautiful. It was so lovely that I tossed my high-heels into my purse and walked to campus that afternoon with a pair of flip-flops. It was as if God himself smiled on the day and decided to make the sky just a little bit bluer and the grass just a little bit greener.  Yes. That day was in technicolor.  But more spectacular than those colors was the energy.  I don't even know how to describe it.

I met so many special people.  I loved the proud twinkle in the parents' eyes when I introduced myself to them. Kind of like meeting one of their children's professors sealed the deal. Yes, my baby is in medical school and my baby is going to be a doctor.  I guess that is something to be proud of, huh?

Well. The entire day was my favorite day. It started casual with soccer and folding chairs and water bottles.  That part was awesome. Then all of that soccer-awesome seamlessly changed over to all of this white-coat-awesome. I realized after seeing all those parents beaming with pride that all the proud-mama-ness that I feel during soccer is really just the beginning. Wow.

half soccer-mom/half amazing

Anyways. It was a special day. But. If I had to pick the very best moment of it all, though, it would have to be this:

After the ceremony we all walked around greeting the families and hugging our newly minted "M.D. candidates."  Some I'd heard about, some had heard about me, and most times a little of both.  There is this one student who shared a week with my team on the wards during the first days of school. The experience was rich and brimming with teachable moments, and he, along with one of his other first-year classmates, drank in every drop.

Unfortunately, there was one part of that week that was bittersweet for him.  His beloved grandfather, who happened to be an Emory School of Medicine alumnus, was nearing his final days.  He was candid in sharing this with me, and of course, I understood his need to abbreviate the week to return home. The day after I learned of this situation, I was surprised to see him on the wards.

"What are you doing here?" I asked him incredulously.

"I decided not to leave yet. I'm going to play it by ear," he said. "I want to stay a little longer."

Play it by who? Say what?

I was really troubled by all of this, quite honestly.  I wanted to send a message to him and the other team members that family is always first.  I needed him not to be heroic by rounding with me at Grady instead of being with his granddad.  But he was firm in his resolve. This student had clearly given all of this careful thought--it was what he wanted to do. I respected his decision.

At the end of that week, I sat the students down to debrief what they'd seen. We discussed their experiences and explored how it made them feel about medicine.  Then I asked about my student's grandfather.  "How is he doing?"

"I will be heading home shortly," he softly replied. "Mom says he's not doing so well. It's getting close."

"Did he know that you were going to be starting medical school at Emory?" I had to know.

"He did."

We all sat in silent deference.  He broke the hush by saying these words. "You know. .  . my grandfather. . .when he heard I was going to be starting med school he said to me, 'When you get there, go off by yourself and just walk around. Look around and ask yourself if this is really what you want to do.'"

I kept my eyes fixed on his and probed. "Did you? Did you do that?"

He nodded quietly.

"What did you decide?"

"Yes. This is what I want to do," he spoke firmly while still holding my gaze.  Then he looked around the room and continued. "My grandfather did his internship right here at Grady Hospital. He and my grandmother lived right up the street from Emory, too.  You know. . . it's almost like I could feel him with me this week. Like. . . like he was there, you know?"

My eyes welled up with tears as his simple truth rang like a tiny bell in my ear.  I cleared my throat of the mounting emotion and said, "So your decision to stay---" I pressed my lips together to keep from crying "--was a decision to be with your grandfather after all."

He smiled bravely and sighed.

Ah hah. Your decision to stay was a decision to stay. Ah hah.

And there we sat. Taking in the magnitude of that moment and what it meant to him to be at Grady Hospital. And now, what his presence for those days meant to all of us.  I tried to imagine his grandfather as an inquisitive medical intern at Grady, scuttling through the halls with hospital whites on. Wow. I felt honored to be the steward of his grandson's experience that week.

"Dr. Manning? This is my grandmother."

This is what I heard that student say to me after the ceremony on Saturday. I faced him in his pristine white coat, filled with the promise of a young doctor's future. Surely that very promise his grandfather held some four decades before. Then I turned and rested my eyes on his grandmother.

I took the hands of this elegant matriarch and took in the complex mixture of pride and sadness in her eyes.  She was beautiful, both physically and spiritually, and I was so glad she was there.

"I am so, so honored to meet you," I emphatically told her.  I meant that because that is truly how I felt.  I knew that after losing her beloved just one month before and taking in the sights and smells of a place she shared with him was hard. But she was there. Strong, resilient, grief-stricken--and there. This was a big deal.

She offered me a smile so tender, I thought I'd cry right then and there.  I composed myself and told her what her grandson had done. "Your grandson brought your husband's legacy to life for us. He honored him by sharing his lessons and mostly by sharing his story.  He also told me all about you.  You know this already but you have a very special grandson."

We instinctively hugged, and it was right.  A knowing hug filled with mutual gratitude for the continuum of life as we know it.  "He is in good hands," I whispered to her.  "And so are we."

She nodded and hugged me once more. And yes, it was still right.

That was just one moment. But do you know there were several others that closely mirrored this? Like for every student there was an intricate tapestry of family and love and sacrifice trailing behind them. I loved seeing it, and just like those students during that first week on the wards, I took in every single drop.


When I walked home, I thought of that encounter with the elegant matriarch repeatedly.  I took in the neighborhood and imagined what it must have been like when she'd walked this very thoroughfare many years before.  Man. I sat on a bench and took a moment to reflect on what this all meant. Me telling this woman that her grandson was "in good hands." Us knighting our students with white coats. The charge we have as stewards, really, of someone's professional upbringing.

Wow. This is a lot.

For the rest of that walk, I took that sage advice and asked myself that question. "Is this what you really want to do?"

Yes.

***
Happy Monday.

Unreasonable doubt.

After the execution of Troy Davis.

This haunted my husband. Haunted him. Gave him nightmares and everything. We sat on the couch together after the kids were off to school and I listened to my husband saying over and over again, "This could happen to me. Totally. This was right here where we live. It's crazy."

And I just nodded and thought about how Harry felt. I also thought about the day when Harry was driving his (own) car down Ponce de Leon Avenue and got pulled over by a cop. That cop hollered in his face with spit flying out of his mouth and demanded Harry to lay on the asphalt. Right next to this busy Atlanta street.

Lay on the who?

Any who know Harry either in real life or virtually through this blog know that Harry wasn't about to get on nobody's ground. But that officer kept pointing and bellowing in his face something about how some "black guy" had just carjacked a woman in a white BMW. Now. Seeing as my husband is in fact a black person--or "black guy" depending on who you ask--who happened to be driving that overpriced white car, then surely it was him, right?

Okay, maybe there was a wee bit of doubt, but still.  Not enough to stop this cop from making this grown ass man lay down on some dirty Midtown concrete. Or at least try to make him.

That story ends with Harry telling that officer his most respectful version of "hell naw" and letting the accuser know that he might really want to check the registration on this car before asking him to "get down" and "put your hands where I can see them."

Registered to a Harry A. Manning. And a "black guy," too.  Imagine that.

No apology.  Just some mumbling about how "it's our job to protect" and some other mess about having a good rest of the day.

Look.  I'm no dummy.  I know that there have been some instances--okay maybe a lot of instances--where a "black guy" committed some sort of crime such as robbing a car or even shooting at a cop. But I'm here to stomp my foot and say that, dammit,  there's a whole lot of other "black guys" out there who aren't. Like my man or my daddy. Brothers who go to work, come home, love on their wives, and pray to their Lord. Every single day. And I can testify that some of them are working hard to train up their own little "black guys" to do great things in this world. They are. They're doing it with all of their might and trying their damnedest to get it right.

It's terrifying to imagine that after all of that, somebody could potentially roll up on one of them one day and force them out of their car and onto some asphalt. Just for looking like they look or being where they are. But what gives the real nightmares is the thought of someone locking them up for two decades and ending their life. . . . .all in the name of the "job to protect."

Look, Mr. Officer. It's our job to protect, too.

We've since gotten rid of that overpriced car. See? We should've known that anything with that high of a note and that cost that much to fill up was nothing but bad news.
***

You know how I feel.

this morning in my kitchen

Birds flyin' high you know how I feel

Sun in the sky you know how I feel
Breeze driftin' on by you know how I feel . . .

It's a new dawn, it's a new day, it's a new life for me
It's a new dawn it's a new day, it's a new life for me . . .

And I'm feeling good.

Fish in the sea, you know how I feel
River runnin' free you know how I feel
Blossom on the tree you know how I feel . . .

It's a new dawn, it's a new day, it's a new life for me . . .

And I'm feelin' good.

Dragonfly out in the sun you know what I mean . . . don't you know?

Butterflies all havin' fun you know what I mean . . . .

Sleepin' peace when day is done -- that's what I mean



And this old world is a new world and a bold world for me . . .

Stars when you shine you know how I feel . . .

Scent of the crime you know how I feel

Freedom is mine, and I know how I feel

It's a new dawn, it's a new day, it's a new life for me . . .

Oh, I'm feeling good.

~ As sung by Nina Simone

"They are new every morning; great is thy faithfulness." ~ Lamentations 3:23

***

That about sums up where I'm at this morning. Happy Wednesday to all.

Now playing on my mental iPod. . .and interestingly, what was playing on Harry's actual iPod when he walked in from his morning run. . . .
Here she is. . .Ms. Nina herself singing what my heart is feeling today and everyday.
Because every sunrise brings a new dawn, a new day, and a new life for me. And I'm feeling good.

Mountains and Mole Hills.

Yesterday I was in a crabby mood because the garage door opener in my car has a dead battery. It's one of those fancy, special batteries that requires you to go over the river and through the woods (read: not in the kitchen "junk drawer") to replace.  

Bleccchh.

The whole act of getting out of my car, manually opening the garage, and then getting back in my car and driving in was just too much for me to bear.

Oh me, oh my.

When I grumbled to Harry about it, he just stared at me exactly like Rhett Butler used to stare ol' entitled Scarlett O'hara like 99% of the time. And whenever he does that, I almost always get a grip. But not yesterday.

"I need you to get me a battery."

To which he Rhett-butted me again.  0_0

"I feel like this falls under a sweet-husband-daddy category. You should do this for me."

And at this point he just decided to ignore me because he knew where I'd be going next. To my utterly nonsensical list of sweet-husband-daddy jobs that for zero logic-based reasons I have decided fall squarely on his shoulders. Especially considering he's the only sweet-husband-daddy in the house. This list includes but is not limited to:

• Changing the weird lithium battery on my garage door opener
• Getting my tires rotated on my car.
• Taking the boys to the barber shop.
• Cleaning off the deck.
• Removing training wheels from bicycles.
• Squashing scary Georgia monstrous-sized palmetto bugs (that to me look like human-sized roaches)
• Telling me that I look hot at least 7.6 times per week.
• Washing the most disgusting pots after I've cooked.
• Exploring all sounds and smells (which in a house built in the 1920's is requested often.)
• Telling me that I am the best wive EVAHHHH at least 8.9 times per week.
• Enforcing bedtime 

Harry has pretty much nailed most of this list. But for whatever reason he continues to resist getting my tires rotated and the weird lithium battery changing.

Anyways.

I continued my whine-fest and marched out of the house. I could overhear Harry mumbling something about people out here with "real problems." Oh, and as a person who works as a property investor, he certainly sees the people with "real problems" -- especially in this economy.

That didn't stop me from pouting though.

Oh. Remind me to tell you guys about how FUTILE it is to complain about anything AT ALL to a former Army Ranger dude. Wait, where was I? Oh, leaving home and fooling with that non-working clicker. Yeah, so I was particularly annoyed when I had to do the manual thing to get out of the garage again. I sure did proceed to give my husband the most Scarlett O' Hairy eyeball I could as I pulled out of there. And so what if he didn't see it, it sure did make me feel better.

I perked up a bit when I got to Grady, which is usually the case. I worked with Carmen M., who I 100% adore and Jason, who probably qualifies as being like a work-sibling to me.  We laughed and learned and taught the residents cool things. The energy was great and, as always, so were the patients. Somewhere in the back of my head, I kept thinking about my interaction with my husband before I left home. I remembered Harry muttering about people and "real problems" and felt a teeny, tiny bit embarrassed by my little rant.

Yup.

Well. . . just as I was feeling that way, I stepped into a room with a resident to see this Grady almost-elder who, despite her age, still worked a full time job. Night shift even. Why? "To keep the lights on."  Anyways. This woman starts telling us about these pains that she's having, and none of them are really correlating with any physical findings. Her labs and tests looked great, and so did she.

So what was up with all this pain? Could it be a manifestation of anxiety or depression? I wasn't sure. From there  I start asking her questions about her life. What do you do? What is it like for you? Are you under stress? How would you describe your day to day life?

And then she shared. Just one tiny piece of her life and boy was it telling.

"I work for 911 dispatch, and it's real, real stressful sometime."

911 dispatch? Damn. I'd never met a person who did this, especially in inner-city Atlanta. Well, this sixty-something year-old woman did just that. She sits at a bank of phones and takes call after call, all night long, from people in emergency situations. All night long. To make ends meet.  To pay the bills.

"It's real hard, sometime. I done heard it all. One night somebody having a heart attack. Another day somebody got shot at. This one lady was on the phone with me and I heard somebody doin' a home invasion on her. She was jest screamin' and screamin'. I wonted to help her so bad but I couldn't, you know? You could hear her door cracking clean off the hinge."

I kept listening.

And so she commenced to tell me all about how hard it is to hold on the phone while people are getting robbed or having life threatening illnesses or  getting the crap kicked out of them by someone who allegedly loves them. That's her job. To hold the receiver and repeatedly tell someone that "it will be okay" or that "someone is on the way." She does this job in a major metropolitan city where someone is not always as "on the way" as one might hope. But these days, according to this patient, things are worse. She explained that she's "been doin' this a long time and ain't never seent it get this bad" and that "folks ain't got nothin' to live for and it's so bad that they don't even care what happen if they do somethin'."

I started biting my cheek listening to her sharing all of this and trying very hard not to think of the truth behind Harry's snarky reply earlier that morning:

"It's people out here with some real problems."

And like the pop of a rubber band I was snapped into reality of what it actually means to have a "problem." Mine that morning seemed a little dumb in comparison. More than a little dumb, actually.

I could go on to talk about how shitty it is to be nearly seventy and required to work this hard. How sad it makes me that she can't work in her garden or hug on her grandbabies all day instead of sleep before her next shift. I could tell you about how she heard someone getting beaten horribly by her spouse and begging for her to help just one day before and how troubled she felt when that woman stopped talking. How my patient wanted to cry or hang up or both because she feared that the worst had happened, but how she couldn't because it's her job and it has benefits and how she didn't because, honestly, isn't this what she hears every single day?  I could go on and tell you all of that . . . but I won't.

Instead I'll just say that in the grand scheme of life and issues, that maybe I needed that stinging snap on my wrist.  Kind of like a nice clean slap across the face like Scarlett O'Hara needed (and if I'm not mistaken actually got.)

No. I don't trivialize every single aspect of my own life and its little mini-hurdles. But I do force myself to take pause more often. . . .shaking my head at the enormity of mountains existing in the midst of my mole hills.  Grady sure helps me with that. And I'm learning that it's a whole lot easier to move mole hills than mountains.


On the way home that evening, I stopped and picked up a dime-sized lithium replacement battery for my garage door opener. It cost me $3.29 and actually was right there in my neighborhood Kroger.

*sigh*

Mole hill moved.

***

And Justice for all.

Oh, just wanted to follow up. Here's a picture of Isaiah this morning with the replacement Jake Justice. Getting the replacement Jake wasn't so easy either. Oh, did I tell you? Turns out the dude has been discontinued. Discontinued!  Well hallelujah for used and collectors items on Amazon. Lawdy Miss Claudie! First the Green Lantern situation and now Jake Justice gets axed from the Rescue Heroes?!  Seriously? Seriously.

Dang. 

Don't worry. I didn't tell Isaiah about the diss-continuation. Besides, I'm told that there's been some sort of crazy ethnic remix on Spiderman and trust me--that'll be confusing enough.

***
Happy Sunday.

Faces of Grady: Hepatitis, see?

My dear, dear friend and (award-winning) Grady doctor, Lesley M., focuses her practice on patients with Hepatitis C.  And let me just share a few things about Hepatitis C.

• Hepatitis C is a viral hepatitis. That means that a person gets infected with a virus (that gets transmitted mostly through blood) which subsequently attacks the liver. 
• Hepatitis C is a smooth criminal. It does its damage slowly . . .kind of like the way termites do. And the same way folks don't realize they have termites until all hell is breaking loose or they get swarmed is the same way Hep C sneaks up. Stealthy, I tell you.
• Some crazy number of people in the U.S. have Hepatitis C. Crazy meaning nearly 3.2 million according to the CDC. And because it's such a ninja, people don't feel sick so they don't know they even have it. In fact, most are shocked to hear they have it. 
• African-Americans are disproportionately affected by Hepatitis C, and also are more likely to have the genotype that is harder to treat.

This lady likes liver.

Okay. So seeing as I work at Grady with Lesley M., it's fair to say that we see our share of folks with Hep C. Well back in the day, shortly after Lesley and I first joined the Grady faculty together,  Lesley and another one of my other favorite people began putting together a better way to help our patients with Hepatitis C. Our other Grady-bff, Natalie L., who has since become the New York equivalent of a Grady doctor (a Bellevue doctor), was one of the people that, along with Lesley, spearheaded what became Grady's "Liver Clinic."

Friends first. Nerdy-public hospital doctors second. Reunion here with our favorite Bellevue doctor, Nat L.

Here's what's cool about what Lesley and others do in the Liver Clinic: First of all, Lesley isn't a hepatologist or to put it in layman's terms, a "liver specialist."  Quite the contrary, actually. Lesley is a general internist (like me) who saw a need for patients that wasn't being met. She has since devoted her time and career to assisting patients with learning about Hepatitis C and especially navigating the oft times tricky task of getting the expensive treatment. Lesley gets with all sorts of people with resources and helps make these available to our patients. She then manages and directs all aspects of their care surrounding Hepatitis C--which takes a tremendous amount of effort, work, and attention to detail.

When you think about the ways that people get Hepatitis C, you realize how awesome it is for our patients to have her there. A lot of people with Hep C have led some hard lives. Some acquired it through injecting IV drugs or getting crude tattoos in jail. Others may have been transfused or come in contact with bodily fluids at some point. And, sure, there are a significant number of people who did none of those things and have no idea how they got it. But where we work, lots of people seen for this have some kind of story.  I like knowing that they can get the treatment they need and deserve without having to get judged at the same time, don't you?

Anywho.

The Liver Lady also teaches the residents, faculty and students about Hep C. I'd go so far as to say that, thanks to her, we are ALL more aware of the need to test patients for Hepatitis C at Grady--and even better, we get them treatment. It's so different than it was when I first started here. We'd try to send our patients with Hep C to our gastroenterologists who were already overwhelmed with multiple other GI issues in our patient population. That, combined with the expense of getting folks treated, meant that people fell between the cracks if they had no insurance (which our patients rarely have.) This woman has, literally, changed the lives of countless people by watching the blind side for folks who don't see cirrhosis coming to tackle them head on. That's what I'm talking about.

Yeah, man.

So recently, the CDC put out these videos on the "Faces of Hepatitis."  Lesley M. was featured in this video that, OMG, I just saw for the first time Thursday. This is absolutely subpar considering she is one of my besties and also the person that caused me to go very close to the ugly cry at Celebratory Grand Rounds last year.

So. . . .here it is. My friend and fellow Grady doctor, Lesley M. talking about treating patients with Hepatitis C. Oh, and if she looks like an amazingly kind and sweet human being? It's only because she is.  I kind of teared up when I watched this--and refuse to watch it again because I'm certain I will full-on cry if I do.

You know why?

First of all, because Lesley is my friend and I respect, love and am proud of her. And second of all because she shows a side of Grady hospital that people don't often see. Many think of what we aren't doing right or feel skeeved out by some of our patients or even imagine it as only a place for trauma. But see, it isn't. It's a place that has people like Lesley M.. . . a woman so accomplished that upon graduating from residency she was awarded the "Best Resident" title. This means she could be anywhere in the world--including a marble building with slick floors and insured patients--but she has chosen to be here. Yes,  she has.

This? Man, this is the Grady I know. And I'm proud to be working shoulder to shoulder with people like Lesley the Liver Lady.

*sniffle*

Damn, I love this place.

***

Get a grip.

What wisdom can sometimes look like.

I heard a talk given by one of the Grady senior faculty on something intriguing. He talked about "Wisdom in Medicine." Bill B., the one who gave this lecture, was the perfect dude to be giving this lecture for a few reasons. I mean, he is wise, yes. But he also has that whole wise persona about himself. White hair and beard. White coat that never, ever seems to have a speck of dirt on it. And all kinds of official letters behind his name after the M.D.

But I'm thinking that wisdom looks like a lot of things. Not just like Bill B. and Dumbledore.

Anywho. Bill B. talked and we listened and then we talked and he listened about wisdom in medicine.  He, too, suggested that wisdom can be found in many places and that we need to role model this for our learners. I was sitting at the end of the table next to one of my favorite Grady doctors, Robin K., who looked over at me and said, "Hey, do you feel wise sometimes?"

And the thing is, I laughed because secretly there are moments where I do. I looked at Robin and said, "You know? I don't know everything. But sometimes I do feel a little bit wise."  And we chuckled because honestly, who admits to being wise?

Just then, Bill B. shows a picture of Socrates and said that "Socrates was the only wise man of his time because he was the only one who didn't think he was wise."

Whoops.  My bad.

Maybe "wise" sounds a bit pompous and pretentious so that's why Socrates avoids claiming it.  Yeah, yeah. Fine, then. How about we refer to it as "mother wit" instead? Yeah. Mother wit.  Mother wit is that knowledge you get with time that can't be found in books. It's mostly learned from trials and errors and watching and sitting at the feet of elders. And Lord knows you don't need to be a doctor to have or gain that kind of wisdom.

This is why that discussion intrigued me so much. I like this idea of talking about the fact that being a good doctor or an effective human being is about more than pouring through articles and regurgitating big scary words and facts. It's about "getting it."  And how many times have all of us been in a situation where you see some aspect of a situation that some really smart-on-paper person just can't seem to get?

Now. Many a time that dunce has been me. Picking through every single fine detail and sifting through medical literature to find an answer when what I really needed was just some mother wit.

Which reminds me.

There was once this man I was caring for who I'll call Mr. Everett. He'd had a stroke and a prolonged hospitalization. Mr. Everett had to learn how to do the most basic things all over again, and lucky for him and us, he was super motivated to do just that. He worked with PT to walk again. He worked with OT (occupational therapy) to lift a fork and comb his hair again, too.  There was only one problem that kept making things difficult. His blood sugar control.

Technically, it wasn't that problem per se. The thing is that Mr. Everett was having issues with eating and chewing after his stroke, which greatly affected his caloric intake. With wacky food intake, the insulin he received for his diabetes was all over the place. Talk about frustrating. He was hell bent on not having any kind of feeding tube placed, yet no matter how many times we tried to advance his diet, he'd gag and sputter and have issues.  He'd passed the swallowing studies and the speech/chew folks assured us that his mechanical ability to eat wasn't the problem. Which kind of sucked considering he'd come so far with regards to everything else.

So on and on it went. Liquids ----> thickened liquids ----> soft mechanical diet ------> regular diet -----> gagging, sputtering, not eating----> thickened liquids --->soft mechanical diet -----> regular -------> gagging, sputtering, not eating. . . .

Uggh.

"Mr. Everett, I'm not sure we can pull off having you eat this regular diet. Even with help, you have trouble," I'd say.

"I don't want no feeding tubes feeding me. I can eat and I want to eat."

That's all he would say. So this went on for easily more than seven days.

Then, one day I come in and see Mr. Everett sitting up in the bed throwing down on his tray. Cutting, slicing, peppering, grubbing. I was totally perplexed, as was his nurse.

"Mr. Everett!" I exclaimed, "You're eating! And swallowing! I'm so happy!"

His nurse had similar things to say and we were so happy that we did the cabbage patch dance around his bed. He simply smiled, swallowed and dug in more.

What the?

And so a few hours later, I'm rounding with the team and gushing about Mr. Everett's esophageal epiphany. I went on and on about him feasting on the breakfast tray and even demonstrated the dance that I did with the nurse.

"I guess it just all finally came together!" the senior resident said with a triumphant smile. "He must have just needed some time."

"Yep. Time seemed to be the key," I responded, "but it's really kind of amazing how all-of-a-sudden it was, you know? Like someone unraveled a mystery."

And we all sat there over tepid coffee, smiling at feeling all proud of ourselves for "curing" Mr. Everett. Now his blood sugars were consistent and he was on his way to getting discharged.  Score.

Then, in comes one of the interns, Nicki M., who'd been off dealing with another patient. Her co-intern looks up and says, "We were just talking about Mr. Everett. Can you believe it? He's eating! Like a champ! Dr. Manning said he cleaned his plate this morning--a regular diet, too!"

We were all so invested in him as a team that, even though Nicki wasn't the primary intern caring for him, this good news was for her, too. Nicki scooted her chair up to the table and nodded. "I'm so glad that worked for him."

I was puzzled by that statement. But his improvement was awfully abrupt, so I couldn't resist getting clarification. "What? What do you mean 'that worked?'"

Nicki rocked on the back legs of the chair and answered with nonchalant shrug, "Poligrip. Extrastrength."

We all looked at each other in disbelief.

Yes. You read that right.  Poligrip. Extrastrength.  

It turns out that Nicki had heard about Mr. Everett so much on rounds that she'd decided to go hang out with him in the middle of the night during her call night. She looked and listened and asked and explored. And you know what she discovered? That at home he uses extrastrength Poligrip for his dentures and that the kind he's been given in the hospital both irritates his gums and doesn't work. Every time he tried to macerate his food, he couldn't. Because his dentures were too loose.


Seriously?

So Nicki called the pharmacy and they didn't have it. The next day, she personally went to CVS and bought him some. Simple as that.

Now. You tell me--was that mother wit or what? Something had told Nicki to go in there that night. It wasn't even her patient, but she went. Something made her think beyond all the technicalities and academic things to something as simple as denture adhesive.  Denture adhesive.

So, yeah. I've had a few of those Poligrip extrastrength moments in my life. And fine. If Socrates doesn't want me to refer to it as wise--I won't. But I think Bill B. was right.  Medicine and life are about a whole lot more than just being smart.  You need the knowledge, yes. But most of all you need you some "mother wit" and an ability to just "get it."

AIDS Walk 2011!

*Warning: Shameless plug ahead

 Every year, I join my small group advisees at Atlanta's beautiful Piedmont Park for the annual AIDS Walk Atlanta and 5K Run. The AIDS Memorial Quilt is put on display and the energy is absolutely amazing. People hugging, laughing, crying, reflecting, and surviving.  It's become our little tradition and a wonderful one at that. See, learning in medical school is about more than just the classroom. It should be about learning to be a good citizen, too. Don't you think?

SG Alpha + SG Beta at AIDS Walk 2009

I am always so moved by the people out there. Every single one with their own story . . . . . .some tell them without words. . . .but you get every detail.

image credit

I walk in honor of my patients at Grady Hospital. I also walk in honor of the sibling of one of my best friends and for the patients my friend and former Grady doctor, Kris R., is caring for in Uganda. Honestly? I'm walking for anybody and everybody who has ever been affected by HIV.

Hmmmm.

Now that I think of it, I'm also walking for my amazing HIV/AIDS-specializing colleague-friends at Grady like David M. and Wendy A. who literally give more of themselves to their patients than I ever thought was possible. Yeah, man. I'm lacing up my Nikes and walking for them, too.

Real talk?

I work at Grady Hospital. We see HIV and AIDS up close and personal every single day. And you know what? So much has changed since I was at the stage my students are. Back then HIV was pretty much an uncertain walk on the plank. But now? Man--it's uplifting to see how far things have come right before my very eyes. And that's because of research and things like the AIDS Walk. It's awesome to be outside feeling the fall air on my face and being reminded of all of these things. And even better to have the medical students by my side.

To get a little more insight on how I really feel about this, check 2009 this post out.

AIDS Walk 2008

AIDS Quilt viewing on Emory Campus - SG Beta

SG Alpha as M2 students - 2008

*And now for the shameless plug:

Feeling benevolent?

Give a little tax-deductible somethin'-somethin' on behalf of our team! Click here to give in the name of Team Manning if the spirit moves you--oh, and don't get it twisted--we'll take whatever we can get. You got ten on it? Decide to skip your latte's for a week and drop a cool $25? Or better yet-- are you grown and someone with racks-on-racks-on-racks who wants to give some totally obscene amount? (The definition of "obscene" depends fully upon your financial situation and your grown-ness.) Hey! It's all for a good cause and goes to AIDS care, education and research. Come on. . . .you know you want to do it. . . especially if you "got racks-on-racks-on-racks."

Money Definitions:

• racks = money, usually in thousand dollar increments
• racks-on-racks-on-racks = a whole bunch of money in thousand dollar increments. Best demonstrated by donating to our team or fanning hand over each rack kind of like this:

balancing rack on head is optional

• stacks = money, usually in thousand dollar increments (e.g. Dang! Dr. Winawer dropped a stack on that new camera he showed us yesterday!)
• tax = what you should be paying if you have either of the above

(Yes, it's a shameless plug for our fundraiser! But at least I didn't ask you to buy some of the wrapping paper my kids are selling at school, man!)

Not your thing? No worries. We will also be accepting donations in the form of good vibes, fist bumps and well-wishes.

(Disclaimer: If you are related to me, that does not apply to you.)

That's all I got. Now, what you got?

'Preciate you!

***
Now. Back to our regularly scheduled programming. . . .Happy Thursday.